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[null,null,null,null,null,"BMC Outpatient CPT & HCPCS Lookup Tool"]
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[null,null,null,"Bill Code",null,null,null,null,"Bill Code"]
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{"sheet":"NDC Lookup Tool","index":2,"n_rows":19,"n_cols":7,"rows_kept":19,"cut":false,"hidden":false,"merged":[[4,4,6,4],[4,9,6,9]]}
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[]
[]
[]
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[null,null,null,"NDC Description",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table - NDC'!$B:$N,6,0),\"-\")","v":"-"}]
[null,null,null,"Average Total Charges",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table - NDC'!$B:$N,9,0),\"-\")","v":"-"}]
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[null,null,null,"Uninsured Rate",{"$f":"IFERROR(VLOOKUP(E$12,'Average Table - NDC'!$B:$N,13,0),\"-\")","v":"-"}]

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["CORRECTIONS","CORRECTIONS NORFOLK"]
["CORRECTIONS","CORRECTIONS NORFOLK CTY CORR"]
["CORRECTIONS","CORRECTIONS PLYMOUTH"]
["CORRECTIONS","CORRECTIONS PLYMOUTH CORR"]
["CORRECTIONS","CORRECTIONS SUFFOLK COUNTY"]
["CORRECTIONS","ZZZCORRECTIONS BAY STATE"]
["CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL"]
["CORRECTIONS","ZZZCORRECTIONS BRADSTON"]
["CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST"]
["CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED"]
["CORRECTIONS","ZZZCORRECTIONS CEDAR"]
["CORRECTIONS","ZZZCORRECTIONS CONCORD"]
["CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON"]
["CORRECTIONS","ZZZCORRECTIONS GARDNER"]
["CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK"]
["CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL"]
["CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB"]
["CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR"]
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["CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR"]
["CORRECTIONS","ZZZCORRECTIONS OLD COLONY"]
["CORRECTIONS","ZZZCORRECTIONS PLYMOUTH"]
["CORRECTIONS","ZZZCORRECTIONS PONDVILLE"]
["CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR"]
["CORRECTIONS","ZZZCORRECTIONS SHIRLEY"]
["CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI"]
["CORRECTIONS","ZZZORRECTIONS FRAMINGHAM"]
["FALLON","FALLON COMMUNITY PLAN"]
["FALLON","FALLON HMO STANDARD"]
["FALLON","FALLON POS STANDARD"]
["FALLON","FALLON PPO STANDARD"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG POS"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG PPO"]
["FALLON MEDICARE MANAGED","FALLON MCR MNG HMO"]
["FALLON SCO","FALLON SCO HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC PPO"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO"]
["HEALTH PLANS INC","HEALTH PLANS INC STANDARD"]
["HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE"]
["HSN","HSN STANDARD"]
["HSN","HSN TEMPORARY"]
["HSN BAD DEBT","HSN BAD DEBT"]
["HSN CONFIDENTIAL","HSN CONFIDENTIAL"]
["HSN DENTAL","HSN DENTAL"]
["HSN PARTIAL","HSN PARTIAL STANDARD"]
["HSN PARTIAL","HSN PARTIAL TEMPORARY"]
["HUMANA MEDICARE","HUMANA MEDICARE STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO"]
["MEDICARE","MEDICARE A&B"]
["MEDICARE","MEDICARE PART A ONLY"]
["MEDICARE","MEDICARE PART B ONLY"]
["MEDICARE","RAILROAD MEDICARE  RAILROAD"]
["NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD"]
["OXFORD HEALTH","OXFORD HEALTH STANDARD"]
["OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD"]
["SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD"]
["TRICARE EAST","TRICARE EAST PRIME (HMO)"]
["TRICARE EAST","TRICARE EAST SELECT"]
["TRICARE FOR LIFE","TRICARE FOR LIFE"]
["TUFTS","TUFTS CARELINK"]
["TUFTS","TUFTS HMO"]
["TUFTS","TUFTS POS"]
["TUFTS","TUFTS PPO"]
["TUFTS","TUFTS SELECT"]
["TUFTS","TUFTS SPIRIT"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED"]
["TUFTS MEDICARE","TUFTS MEDICARE HMO"]
["TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS"]
["TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS"]
["UBH HPHC","UBH HPHC"]
["UNICARE","UNICARE STANDARD"]
["UNITED","UNITED DEFINITY HRA"]
["UNITED","UNITED HP SHIP"]
["UNITED","UNITED HP STUDENT HEALTH"]
["UNITED","UNITED NAVIGATE"]
["UNITED","UNITED PASSPORT CONNECT"]
["UNITED","UNITED STANDARD"]
["UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO"]
["UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD"]
["UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG HMO"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG PPO"]
["UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO"]
["UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO"]
["UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD"]
["WELLCARE","WELLCARE HMO"]
["WELLCARE","WELLCARE PPO"]
["WELLCARE","WELLCARE STANDARD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS"]
["WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP"]
["WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE"]
["WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT"]
["WORKERS COMP","WORKERS COMP CCMSI"]
["WORKERS COMP","WORKERS COMP CITY OF BOSTON"]
["WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS"]
["WORKERS COMP","WORKERS COMP COVE RISK"]
["WORKERS COMP","WORKERS COMP GALLAGHER BASSETT"]
["WORKERS COMP","WORKERS COMP GUARD INSURANCE"]
["WORKERS COMP","WORKERS COMP LIBERTY MUTUAL"]
["WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS"]
["WORKERS COMP","WORKERS COMP MBTA"]
["WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT"]
["WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS"]
["WORKERS COMP","WORKERS COMP STANDARD"]
["WORKERS COMP","WORKERS COMP THE HARTFORD"]
["WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR"]
["WORKERS COMP","ZZZWORKERS COMP AIG"]
["WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND"]
["WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS"]
["WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT"]
["WORKERS COMP","ZZZWORKERS COMP BROADSPIRE"]
["WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY"]
["ZZZAETNA","ZZZAETNA HMO"]
["ZZZAETNA","ZZZAETNA MCR SUPP"]
["ZZZAETNA","ZZZAETNA POS"]
["ZZZAETNA","ZZZAETNA PPO-EPO"]
["ZZZAETNA","ZZZAETNA STUDENT HEALTH"]
["ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD"]
["ZZZCCA ONECARE","ZZZCCA ONECARE"]
["ZZZCCA ONECARE","ZZZCCA SCO ONECARE"]
["ZZZCIGNA","CIGNA LOCALPLUS"]
["ZZZCIGNA","ZZZCIGNA CARELINK"]
["ZZZCIGNA","ZZZCIGNA STANDARD"]
["ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD"]
["ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD"]
["ZZZUNITED","ZZZUNITED DEFINITY HRA"]
["ZZZUNITED","ZZZUNITED HP SHIP"]
["ZZZUNITED","ZZZUNITED HP STUDENT HEALTH"]
["ZZZUNITED","ZZZUNITED PASSPORT CONNECT"]
["ZZZUNITED","ZZZUNITED STANDARD"]

{"sheet":"PayerPlanCount (NDC)","index":4,"n_rows":212,"n_cols":10,"rows_kept":212,"cut":false,"hidden":true,"merged":[[0,0,0,1],[0,5,0,6]]}
["Unique Payer Plan combination",null,null,null,null,"Plan Count by Payer",null,null,null,"Unique Payers"]
["Payer","Plan",null,null,null,"Payer","Count of Plan",null,null,"Payer"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED",null,null,null,"CORRECTIONS",42,null,null,"AARP UHC MEDICARE COMPLETE"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO",null,null,null,"WORKERS COMP",23,null,null,"AETNA"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO",null,null,null,"TUFTS CONNCARE/QHP",13,null,null,"AETNA MEDICARE MANAGED"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD",null,null,null,"BCBS",7,null,null,"BCBS"]
["AETNA","AETNA HMO",null,null,null,"UNITED",6,null,null,"BCBS MEDICARE MANAGED"]
["AETNA","AETNA MCR SUPP",null,null,null,"HARVARD PILGRIM HEALTH CARE",6,null,null,"BCBS OUT OF STATE"]
["AETNA","AETNA POS",null,null,null,"TUFTS",6,null,null,"CCA"]
["AETNA","AETNA PPO EPO",null,null,null,"AETNA",5,null,null,"CCA MEDICARE PREFERRED"]
["AETNA","AETNA STUDENT HEALTH",null,null,null,"UNITED MEDICARE MANAGED",5,null,null,"CIGNA"]
["AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD",null,null,null,"TUFTS MEDICARE MANAGED",5,null,null,"CORRECTIONS"]
["BCBS","BCBS HMO",null,null,null,"ZZZAETNA",5,null,null,"FALLON"]
["BCBS","BCBS INDEMNITY",null,null,null,"ZZZUNITED",5,null,null,"FALLON MEDICARE MANAGED"]
["BCBS","BCBS POS",null,null,null,"FALLON",4,null,null,"FALLON SCO"]
["BCBS","BCBS PPO",null,null,null,"HEALTH PLANS INC",4,null,null,"HARVARD PILGRIM HEALTH CARE"]
["BCBS","BCBS SHIP PPO",null,null,null,"BCBS OUT OF STATE",4,null,null,"HEALTH PLANS INC"]
["BCBS","BCBS STANDARD",null,null,null,"ZZZHEALTH PLANS INC",4,null,null,"HPHC MEDICARE MANAGED"]
["BCBS","BLUE BENEFITS ADMINISTRATORS OF MA",null,null,null,"AARP UHC MEDICARE COMPLETE",4,null,null,"HSN"]
["BCBS MEDICARE MANAGED","BCBS MCR MNG HMO",null,null,null,"MEDICARE",4,null,null,"HSN BAD DEBT"]
["BCBS MEDICARE MANAGED","BCBS MCR MNG PPO",null,null,null,"CIGNA",3,null,null,"HSN CONFIDENTIAL"]
["BCBS OUT OF STATE","BCBS OUT OF STATE HMO",null,null,null,"WELLCARE",3,null,null,"HSN DENTAL"]
["BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY",null,null,null,"ZZZCIGNA",3,null,null,"HSN PARTIAL"]
["BCBS OUT OF STATE","BCBS OUT OF STATE POS",null,null,null,"FALLON MEDICARE MANAGED",3,null,null,"HUMANA MEDICARE"]
["BCBS OUT OF STATE","BCBS OUT OF STATE PPO",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL",3,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL"]
["CCA","CCA SCO ONECARE",null,null,null,"CCA MEDICARE PREFERRED",3,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME"]
["CCA","CCA SCO STANDARD",null,null,null,"CCA",3,null,null,"MEDICARE"]
["CCA","ZZZCCA STANDARD",null,null,null,"TRICARE EAST",2,null,null,"NEIGHBORHOOD PACE"]
["CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO",null,null,null,"ZZZCCA ONECARE",2,null,null,"OXFORD HEALTH"]
["CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO",null,null,null,"BCBS MEDICARE MANAGED",2,null,null,"SENIOR WHOLE HEALTH"]
["CCA MEDICARE PREFERRED","ZZZCCA",null,null,null,"HSN",2,null,null,"TRICARE EAST"]
["CIGNA","CIGNA CARELINK",null,null,null,"SENIOR WHOLE HEALTH",2,null,null,"TRICARE FOR LIFE"]
["CIGNA","CIGNA LOCALPLUS",null,null,null,"WELLSENSE MEDICARE MANAGED",2,null,null,"TUFTS"]
["CIGNA","CIGNA STANDARD",null,null,null,"UNITED COMMUNITY PLAN",2,null,null,"TUFTS CONNCARE/QHP"]
["CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY",null,null,null,"HSN PARTIAL",2,null,null,"TUFTS MEDICARE"]
["CORRECTIONS","CORRECTIONS BRISTOL",null,null,null,"OXFORD HEALTH",2,null,null,"TUFTS MEDICARE MANAGED"]
["CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ",null,null,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND",1,null,null,"UBH HPHC"]
["CORRECTIONS","CORRECTIONS DEVENS PROGRAM",null,null,null,"ZZZBU EMPLOYEE WORK COMP",1,null,null,"UNICARE"]
["CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC",null,null,null,"UBH HPHC",1,null,null,"UNITED"]
["CORRECTIONS","CORRECTIONS ESSEX SALISBURY",null,null,null,"UNICARE",1,null,null,"UNITED COMMUNITY PLAN"]
["CORRECTIONS","CORRECTIONS HAMPDEN COUNTY",null,null,null,"HUMANA MEDICARE",1,null,null,"UNITED MEDICARE MANAGED"]
["CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME",1,null,null,"UPHAMS CORNER ESP"]
["CORRECTIONS","CORRECTIONS ICE INMATE",null,null,null,"ZZZRAILROAD MEDICARE",1,null,null,"WELLCARE"]
["CORRECTIONS","CORRECTIONS MIDDLESEX",null,null,null,"AETNA MEDICARE MANAGED",1,null,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE"]
["CORRECTIONS","CORRECTIONS NAPHCARE",null,null,null,"TRICARE FOR LIFE",1,null,null,"WELLSENSE MEDICARE MANAGED"]
["CORRECTIONS","CORRECTIONS NASHUA",null,null,null,"NEIGHBORHOOD PACE",1,null,null,"WORKERS COMP"]
["CORRECTIONS","CORRECTIONS NORFOLK",null,null,null,"FALLON SCO",1,null,null,"ZZZAETNA"]
["CORRECTIONS","CORRECTIONS NORFOLK CTY CORR",null,null,null,"UPHAMS CORNER ESP",1,null,null,"ZZZBU EMPLOYEE WORK COMP"]
["CORRECTIONS","CORRECTIONS PLYMOUTH",null,null,null,"ZZZCITY OF BOSTON WORK COMP",1,null,null,"ZZZCCA ONECARE"]
["CORRECTIONS","CORRECTIONS PLYMOUTH CORR",null,null,null,"HSN BAD DEBT",1,null,null,"ZZZCIGNA"]
["CORRECTIONS","CORRECTIONS SUFFOLK COUNTY",null,null,null,"TUFTS MEDICARE",1,null,null,"ZZZCITY OF BOSTON WORK COMP"]
["CORRECTIONS","ZZZCORRECTIONS BAY STATE",null,null,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE",1,null,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND"]
["CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL",null,null,null,"HPHC MEDICARE MANAGED",1,null,null,"ZZZHEALTH PLANS INC"]
["CORRECTIONS","ZZZCORRECTIONS BRADSTON",null,null,null,"HSN CONFIDENTIAL",1,null,null,"ZZZRAILROAD MEDICARE"]
["CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST",null,null,null,"HSN DENTAL",1,null,null,"ZZZUNITED"]
["CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED",null,null,null,"Grand Total",210]
["CORRECTIONS","ZZZCORRECTIONS CEDAR"]
["CORRECTIONS","ZZZCORRECTIONS CONCORD"]
["CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON"]
["CORRECTIONS","ZZZCORRECTIONS GARDNER"]
["CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK"]
["CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL"]
["CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB"]
["CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR"]
["CORRECTIONS","ZZZCORRECTIONS NASHUA"]
["CORRECTIONS","ZZZCORRECTIONS NORFOLK"]
["CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR"]
["CORRECTIONS","ZZZCORRECTIONS OLD COLONY"]
["CORRECTIONS","ZZZCORRECTIONS PLYMOUTH"]
["CORRECTIONS","ZZZCORRECTIONS PONDVILLE"]
["CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR"]
["CORRECTIONS","ZZZCORRECTIONS SHIRLEY"]
["CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI"]
["CORRECTIONS","ZZZORRECTIONS FRAMINGHAM"]
["FALLON","FALLON COMMUNITY PLAN"]
["FALLON","FALLON HMO STANDARD"]
["FALLON","FALLON POS STANDARD"]
["FALLON","FALLON PPO STANDARD"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG POS"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG PPO"]
["FALLON MEDICARE MANAGED","FALLON MCR MNG HMO"]
["FALLON SCO","FALLON SCO HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC PPO"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO"]
["HEALTH PLANS INC","HEALTH PLANS INC STANDARD"]
["HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE"]
["HSN","HSN STANDARD"]
["HSN","HSN TEMPORARY"]
["HSN BAD DEBT","HSN BAD DEBT"]
["HSN CONFIDENTIAL","HSN CONFIDENTIAL"]
["HSN DENTAL","HSN DENTAL"]
["HSN PARTIAL","HSN PARTIAL STANDARD"]
["HSN PARTIAL","HSN PARTIAL TEMPORARY"]
["HUMANA MEDICARE","HUMANA MEDICARE STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO"]
["MEDICARE","MEDICARE A&B"]
["MEDICARE","MEDICARE PART A ONLY"]
["MEDICARE","MEDICARE PART B ONLY"]
["MEDICARE","RAILROAD MEDICARE  RAILROAD"]
["NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD"]
["OXFORD HEALTH","OXFORD HEALTH STANDARD"]
["OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD"]
["SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD"]
["TRICARE EAST","TRICARE EAST PRIME (HMO)"]
["TRICARE EAST","TRICARE EAST SELECT"]
["TRICARE FOR LIFE","TRICARE FOR LIFE"]
["TUFTS","TUFTS CARELINK"]
["TUFTS","TUFTS HMO"]
["TUFTS","TUFTS POS"]
["TUFTS","TUFTS PPO"]
["TUFTS","TUFTS SELECT"]
["TUFTS","TUFTS SPIRIT"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED"]
["TUFTS MEDICARE","TUFTS MEDICARE HMO"]
["TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS"]
["TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS"]
["UBH HPHC","UBH HPHC"]
["UNICARE","UNICARE STANDARD"]
["UNITED","UNITED DEFINITY HRA"]
["UNITED","UNITED HP SHIP"]
["UNITED","UNITED HP STUDENT HEALTH"]
["UNITED","UNITED NAVIGATE"]
["UNITED","UNITED PASSPORT CONNECT"]
["UNITED","UNITED STANDARD"]
["UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO"]
["UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD"]
["UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG HMO"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG PPO"]
["UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO"]
["UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO"]
["UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD"]
["WELLCARE","WELLCARE HMO"]
["WELLCARE","WELLCARE PPO"]
["WELLCARE","WELLCARE STANDARD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS"]
["WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP"]
["WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE"]
["WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT"]
["WORKERS COMP","WORKERS COMP CCMSI"]
["WORKERS COMP","WORKERS COMP CITY OF BOSTON"]
["WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS"]
["WORKERS COMP","WORKERS COMP COVE RISK"]
["WORKERS COMP","WORKERS COMP GALLAGHER BASSETT"]
["WORKERS COMP","WORKERS COMP GUARD INSURANCE"]
["WORKERS COMP","WORKERS COMP LIBERTY MUTUAL"]
["WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS"]
["WORKERS COMP","WORKERS COMP MBTA"]
["WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT"]
["WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS"]
["WORKERS COMP","WORKERS COMP STANDARD"]
["WORKERS COMP","WORKERS COMP THE HARTFORD"]
["WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR"]
["WORKERS COMP","ZZZWORKERS COMP AIG"]
["WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND"]
["WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS"]
["WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT"]
["WORKERS COMP","ZZZWORKERS COMP BROADSPIRE"]
["WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY"]
["ZZZAETNA","ZZZAETNA HMO"]
["ZZZAETNA","ZZZAETNA MCR SUPP"]
["ZZZAETNA","ZZZAETNA POS"]
["ZZZAETNA","ZZZAETNA PPO-EPO"]
["ZZZAETNA","ZZZAETNA STUDENT HEALTH"]
["ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD"]
["ZZZCCA ONECARE","ZZZCCA ONECARE"]
["ZZZCCA ONECARE","ZZZCCA SCO ONECARE"]
["ZZZCIGNA","CIGNA LOCALPLUS"]
["ZZZCIGNA","ZZZCIGNA CARELINK"]
["ZZZCIGNA","ZZZCIGNA STANDARD"]
["ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO"]
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["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO"]
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["ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD"]
["ZZZUNITED","ZZZUNITED DEFINITY HRA"]
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["ZZZUNITED","ZZZUNITED HP STUDENT HEALTH"]
["ZZZUNITED","ZZZUNITED PASSPORT CONNECT"]
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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-0893-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-0893-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-0893-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-0893-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-0893-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-0893-31 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-0893-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-0893-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-3734-13 - PR INJECTION, NIVOLUMAB"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"00003-4522-11 - 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PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00069-1305-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00069-1305-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-1070-01 - PR INJ RISANKIZUMAB-RZAA 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7686-01 - PR ALPROSTADIL FOR INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00069-0305-01 - PR INJ., TRAZIMERA, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3473-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(74:74))),\"\" )","v":"00009-7529-04 - 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PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(75:75))),\"\" )","v":"00074-3473-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(75:75))),\"\" )","v":"00069-1306-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(75:75))),\"\" )","v":"00069-1306-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(75:75))),\"\" )","v":"00074-3473-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(75:75))),\"\" )","v":"00009-7686-01 - PR ALPROSTADIL FOR INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(75:75))),\"\" )","v":"00009-7686-01 - 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PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3641-03 - PR LEUPROLIDE ACETATE /3.75 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00013-5301-17 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00013-1114-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00013-1114-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00069-0315-01 - 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PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00013-1114-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00013-1114-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00013-1114-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00013-1114-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00013-1114-21 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(77:77))),\"\" )","v":"00074-3642-03 - 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PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(84:84))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"}]
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PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00023-3205-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(85:85))),\"\" )","v":"00075-0624-30 - 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PR OCTREOTIDE INJECTION, DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(91:91))),\"\" )","v":"00078-0790-61 - PR OCTREOTIDE INJECTION, DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(91:91))),\"\" )","v":"00069-4494-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(91:91))),\"\" )","v":"00069-4494-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(91:91))),\"\" )","v":"00078-0790-61 - PR OCTREOTIDE INJECTION, DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(91:91))),\"\" )","v":"00023-9163-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(91:91))),\"\" )","v":"00023-9163-30 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00074-5015-01 - PR INJ RISANKIZUMAB-RZAA 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00046-1100-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00078-0639-68 - PR UNCLASSIFIED BIOLOGICS"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(110:110))),\"\" )","v":"00074-5015-01 - PR INJ RISANKIZUMAB-RZAA 1 MG"}]
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PR LEUPROLIDE ACETATE /3.75 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00078-0734-61 - PR CANAKINUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00078-0734-61 - PR CANAKINUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00049-0013-81 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00074-9694-03 - PR LEUPROLIDE ACETATE /3.75 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00046-1102-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(111:111))),\"\" )","v":"00143-9331-01 - 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["AARP UHC MEDICARE COMPLETE","00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG",null,null,{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(E$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(F$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(G$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(H$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00075-0621-60 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(I$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(J$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00075-0621-60 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00049-0014-83 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00075-0621-60 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00046-1104-81 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00078-0790-61 - PR OCTREOTIDE INJECTION, DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(112:112))),\"\" )","v":"00075-0621-60 - PR INJ ENOXAPARIN SODIUM"}]
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PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00049-0013-81 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00049-0013-81 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00078-0797-61 - PR OCTREOTIDE INJECTION, DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00078-0797-61 - PR OCTREOTIDE INJECTION, DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00049-0013-81 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(113:113))),\"\" )","v":"00049-0013-81 - 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PR LEVOFLOXACIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(131:131))),\"\" )","v":"00143-9720-01 - PR LEVOFLOXACIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(131:131))),\"\" )","v":"00143-9702-01 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(131:131))),\"\" )","v":"00143-9720-01 - PR LEVOFLOXACIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(131:131))),\"\" )","v":"00143-9720-01 - PR LEVOFLOXACIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(131:131))),\"\" )","v":"00143-9720-01 - PR LEVOFLOXACIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(131:131))),\"\" )","v":"00054-0057-46 - 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PR FACTOR VIIA"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(140:140))),\"\" )","v":"00169-7201-01 - PR FACTOR VIIA"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(140:140))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(140:140))),\"\" )","v":"00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(140:140))),\"\" )","v":"00169-7201-01 - PR FACTOR VIIA"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(140:140))),\"\" )","v":"00054-0177-13 - PR BUPRENOPHONE ORAL 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(140:140))),\"\" )","v":"00054-0177-13 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(147:147))),\"\" )","v":"00054-0244-25 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(147:147))),\"\" )","v":"00054-0244-25 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(147:147))),\"\" )","v":"00264-7578-10 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(147:147))),\"\" )","v":"00054-0244-25 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(147:147))),\"\" )","v":"00054-0244-25 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(147:147))),\"\" )","v":"00264-7578-10 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(147:147))),\"\" )","v":"00264-7578-10 - 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PR INJECTION, FULVESTRANT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(155:155))),\"\" )","v":"00310-0720-10 - PR INJECTION, FULVESTRANT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(155:155))),\"\" )","v":"00143-9674-01 - PR ARGATROBAN NONESRD USE 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(155:155))),\"\" )","v":"00143-9674-01 - PR ARGATROBAN NONESRD USE 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(155:155))),\"\" )","v":"00310-0720-10 - PR INJECTION, FULVESTRANT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(155:155))),\"\" )","v":"00054-0709-20 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(155:155))),\"\" )","v":"00054-0709-20 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00054-3117-63 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00054-3117-63 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00054-3117-63 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00310-3040-00 - ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00054-3117-63 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00054-3117-63 - 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ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00054-3177-63 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00054-3117-63 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00310-3040-00 - ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00310-3040-00 - ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00310-3040-00 - ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(156:156))),\"\" )","v":"00054-3117-63 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(157:157))),\"\" )","v":"00054-3120-41 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(157:157))),\"\" )","v":"00310-4505-25 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(157:157))),\"\" )","v":"00310-4505-25 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(157:157))),\"\" )","v":"00310-4505-25 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(157:157))),\"\" )","v":"00054-3120-41 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(157:157))),\"\" )","v":"00143-9398-01 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(173:173))),\"\" )","v":"00054-4496-25 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(173:173))),\"\" )","v":"00338-0691-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(173:173))),\"\" )","v":"00338-0691-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(173:173))),\"\" )","v":"00338-0691-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(173:173))),\"\" )","v":"00054-4496-25 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(173:173))),\"\" )","v":"00143-9709-10 - PR INJ MILRINONE LACTATE / 5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(173:173))),\"\" )","v":"00338-0691-04 - 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PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(174:174))),\"\" )","v":"00338-0695-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(174:174))),\"\" )","v":"00173-0881-01 - PR INJECTION, MEPOLIZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(174:174))),\"\" )","v":"00173-0881-01 - PR INJECTION, MEPOLIZUMAB, 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(174:174))),\"\" )","v":"00338-0695-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(174:174))),\"\" )","v":"00054-4581-11 - PR ORAL PRESCRIPTION DRUG CHEMO"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(174:174))),\"\" )","v":"00054-4581-11 - 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PR INJ., TRAZIMERA, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(203:203))),\"\" )","v":"00069-0308-01 - PR INJ., TRAZIMERA, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(203:203))),\"\" )","v":"00409-1159-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(203:203))),\"\" )","v":"00338-0675-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(203:203))),\"\" )","v":"00409-1159-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(203:203))),\"\" )","v":"00270-0445-40 - PR HOCM 350-399MG/ML IODINE,1ML"}]
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LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00338-0683-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00338-0683-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1159-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0469-56 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00270-1315-30 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00069-0315-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00338-0683-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(204:204))),\"\" )","v":"00270-1315-30 - LOCM 300-399MG/ML IODINE,1ML"}]
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LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00338-0691-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00338-0691-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0809-01 - PR INJECTION, INFLECTRA"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00270-1316-35 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1162-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00069-0342-01 - PR INJ., ZIRABEV, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00338-0691-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(205:205))),\"\" )","v":"00270-1316-35 - LOCM 300-399MG/ML IODINE,1ML"}]
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LOCM 200-299MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00409-1162-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00409-1162-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00069-0469-56 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00409-1162-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00069-0469-56 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00409-1162-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00409-1162-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00338-0695-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00338-0695-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00409-1162-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00069-0469-56 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(206:206))),\"\" )","v":"00069-0469-56 - 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PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00409-1165-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00069-1306-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00069-1306-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00069-1306-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00409-1165-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00069-1306-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00069-1306-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00409-1165-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00338-0803-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00409-1165-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(210:210))),\"\" )","v":"00310-4535-30 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"}]
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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00338-0807-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00338-0807-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1308-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00338-0054-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00069-1307-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00338-0807-04 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(211:211))),\"\" )","v":"00338-0054-03 - HC 250 SHELL"}]
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PR DOXORUBICIN INJ 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00338-1007-02 - PR DOPAMINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00338-1007-02 - PR DOPAMINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1309-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00338-0067-01 - PR DOXORUBICIN INJ 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00069-1308-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00338-1007-02 - PR DOPAMINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(212:212))),\"\" )","v":"00338-0067-01 - PR DOXORUBICIN INJ 10MG"}]
["AARP UHC MEDICARE COMPLETE","00409-1390-21 - PR MEROPENEM",null,null,{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(E$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(213:213))),\"\" )","v":"00409-1165-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(F$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(213:213))),\"\" )","v":"00069-1308-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(G$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(213:213))),\"\" )","v":"00409-1165-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(H$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(213:213))),\"\" )","v":"00338-0072-25 - PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(I$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(213:213))),\"\" )","v":"00409-1165-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(J$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(213:213))),\"\" )","v":"00338-0072-25 - 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PR 5% DEXTROSE/NORMAL SALINE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1390-51 - PR MEROPENEM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-2522-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00338-0089-03 - PR 5% DEXTROSE/NORMAL SALINE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00069-1311-01 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(216:216))),\"\" )","v":"00338-0089-03 - PR 5% DEXTROSE/NORMAL SALINE"}]
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PR 5% DEXTROSE/NORMAL SALINE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00069-1311-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00069-1311-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00338-1077-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00338-1077-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00069-1311-10 - PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00069-1311-10 - 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PR INJ RETACRIT NON-ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(217:217))),\"\" )","v":"00409-1559-30 - 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PR RINGERS LACTATE INFUSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00069-2522-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00069-2522-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00409-1560-10 - 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PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00069-2522-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00069-2522-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00069-2522-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00069-2522-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00069-2522-01 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00338-1305-01 - PR MESNA INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(218:218))),\"\" )","v":"00338-0117-04 - PR RINGERS LACTATE INFUSION"}]
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PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00338-3508-41 - PR INJ CEFAZOLIN SODIUM, BAXTER"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00338-3508-41 - PR INJ CEFAZOLIN SODIUM, BAXTER"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-3032-20 - PR DOXORUBIC HCL 10 MG VL CHEMO"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00338-0357-03 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1582-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00069-2522-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00338-3508-41 - PR INJ CEFAZOLIN SODIUM, BAXTER"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(219:219))),\"\" )","v":"00338-0357-03 - PR MANNITOL INJECTION"}]
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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(225:225))),\"\" )","v":"00069-3150-84 - PR AZITHROMYCIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(225:225))),\"\" )","v":"00409-1630-10 - PR ATROPINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(225:225))),\"\" )","v":"00409-1630-10 - PR ATROPINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(225:225))),\"\" )","v":"00409-1630-10 - PR ATROPINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(225:225))),\"\" )","v":"00069-3150-84 - PR AZITHROMYCIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(225:225))),\"\" )","v":"00338-0691-04 - 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PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(226:226))),\"\" )","v":"00069-4061-89 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(226:226))),\"\" )","v":"00069-4061-89 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(226:226))),\"\" )","v":"00069-4061-89 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(226:226))),\"\" )","v":"00409-1630-15 - PR ATROPINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(226:226))),\"\" )","v":"00069-4061-89 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(226:226))),\"\" )","v":"00069-4061-89 - 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PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(228:228))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(228:228))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(228:228))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(228:228))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(228:228))),\"\" )","v":"00069-4494-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(228:228))),\"\" )","v":"00069-4220-30 - 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PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00378-8767-93 - PR BUPRENORPH/NALOX 6.1 TO 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00378-8767-93 - PR BUPRENORPH/NALOX 6.1 TO 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-4494-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-4494-02 - 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PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-5800-60 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-4494-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-4494-02 - 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PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-4494-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-4494-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-4494-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(230:230))),\"\" )","v":"00069-4494-02 - 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PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(231:231))),\"\" )","v":"00409-2222-01 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(231:231))),\"\" )","v":"00409-2222-01 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(231:231))),\"\" )","v":"00069-5800-43 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(231:231))),\"\" )","v":"00409-2222-01 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(231:231))),\"\" )","v":"00069-5800-43 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(231:231))),\"\" )","v":"00409-2222-01 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00074-3826-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00074-3826-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00074-3826-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00409-3515-11 - PR INJ, VANCOMYCIN HCL (MYLAN)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00074-3826-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00074-3826-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00409-3515-11 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00074-3826-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00409-3515-11 - PR INJ, VANCOMYCIN HCL (MYLAN)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00409-3515-11 - PR INJ, VANCOMYCIN HCL (MYLAN)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00409-3515-11 - PR INJ, VANCOMYCIN HCL (MYLAN)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00074-3826-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(256:256))),\"\" )","v":"00409-0367-01 - 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PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(257:257))),\"\" )","v":"00409-3724-11 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(257:257))),\"\" )","v":"00409-3515-11 - PR INJ, VANCOMYCIN HCL (MYLAN)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(257:257))),\"\" )","v":"00409-3724-11 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(257:257))),\"\" )","v":"00409-3724-11 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(257:257))),\"\" )","v":"00409-3724-11 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(257:257))),\"\" )","v":"00074-4380-10 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(263:263))),\"\" )","v":"00074-5182-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(263:263))),\"\" )","v":"00409-4520-02 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(263:263))),\"\" )","v":"00409-4520-02 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(263:263))),\"\" )","v":"00409-4520-02 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(263:263))),\"\" )","v":"00074-5182-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(263:263))),\"\" )","v":"00409-1159-02 - 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PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(268:268))),\"\" )","v":"00409-4933-11 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(268:268))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(268:268))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(268:268))),\"\" )","v":"00409-4933-11 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(268:268))),\"\" )","v":"00074-7068-11 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(268:268))),\"\" )","v":"00074-7068-11 - 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PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00075-0626-03 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00075-0623-00 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00409-6653-05 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00409-6653-05 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00409-6653-05 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00075-0623-00 - 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PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00409-6653-05 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00075-0623-00 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00075-0623-00 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00075-0623-00 - PR INJ ENOXAPARIN SODIUM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00409-6653-05 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(276:276))),\"\" )","v":"00075-0623-00 - 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PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-2339-24 - PR INJ, LABETALOL HCL, 5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-2339-24 - PR INJ, LABETALOL HCL, 5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00078-0249-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00078-0249-15 - 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PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6727-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-24 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-24 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00078-0357-52 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00078-0249-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00078-0249-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00078-0249-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-24 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00078-0249-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00409-6729-23 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(279:279))),\"\" )","v":"00078-0249-15 - 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PR REGADENOSON INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-6501-89 - PR REGADENOSON INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-0871-30 - PR ADENOSINE INJ 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-6501-89 - PR REGADENOSON INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00487-9003-30 - PR STERILE WATER/SALINE, 10 ML"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00487-9003-30 - PR STERILE WATER/SALINE, 10 ML"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00078-1000-60 - PR INJECTION, INCLISIRAN, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00078-0876-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-6501-89 - PR REGADENOSON INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-6501-89 - PR REGADENOSON INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-6501-89 - PR REGADENOSON INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00078-0876-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00409-2347-32 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-6501-89 - PR REGADENOSON INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-6501-89 - PR REGADENOSON INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00078-0876-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00487-9003-30 - PR STERILE WATER/SALINE, 10 ML"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00078-0876-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(305:305))),\"\" )","v":"00469-6501-89 - 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PR IRON SUCROSE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(326:326))),\"\" )","v":"00517-2340-25 - PR IRON SUCROSE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(326:326))),\"\" )","v":"00517-2340-10 - PR IRON SUCROSE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(326:326))),\"\" )","v":"00517-2340-25 - PR IRON SUCROSE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(326:326))),\"\" )","v":"00517-4300-01 - PR INJ PACLITAXEL (AMERICAN REGENT)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(326:326))),\"\" )","v":"00517-4300-01 - PR INJ PACLITAXEL (AMERICAN REGENT)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(326:326))),\"\" )","v":"00093-0810-01 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00093-0810-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00517-4602-25 - INJ, GLYCOPYRROLATE, 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00517-4602-25 - INJ, GLYCOPYRROLATE, 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00517-4602-25 - INJ, GLYCOPYRROLATE, 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00093-0810-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00409-4520-30 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00517-4602-25 - INJ, GLYCOPYRROLATE, 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00517-4602-25 - INJ, GLYCOPYRROLATE, 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00093-0810-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00517-4605-25 - INJ, GLYCOPYRROLATE, 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00093-0810-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(328:328))),\"\" )","v":"00517-4602-25 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(349:349))),\"\" )","v":"00093-3107-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(349:349))),\"\" )","v":"00641-6003-25 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(349:349))),\"\" )","v":"00641-6003-25 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(349:349))),\"\" )","v":"00641-6003-25 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(349:349))),\"\" )","v":"00093-3107-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(349:349))),\"\" )","v":"00409-7335-03 - PR CEFTRIAXONE SODIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(349:349))),\"\" )","v":"00641-6003-25 - 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PR CEFTRIAXONE SODIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00409-7335-13 - PR CEFTRIAXONE SODIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00093-3109-53 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00409-9157-50 - PR VITAMIN K PHYTONADIONE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(350:350))),\"\" )","v":"00409-7335-13 - PR CEFTRIAXONE SODIUM INJECTION"}]
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PR CEFTRIAXONE SODIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00409-9158-01 - PR VITAMIN K PHYTONADIONE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00409-9158-01 - PR VITAMIN K PHYTONADIONE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3127-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00409-7337-01 - PR CEFTRIAXONE SODIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-10 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00093-3123-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(351:351))),\"\" )","v":"00409-9158-01 - 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PR HYDRALAZINE HCL INJECTION"}]
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PR CEFTRIAXONE SODIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00115-3511-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00115-1694-30 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00781-3154-01 - PR FERUMOXYTOL, ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00781-3154-01 - PR FERUMOXYTOL, ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00781-3154-01 - PR FERUMOXYTOL, ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00115-1694-30 - 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PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00781-3154-01 - PR FERUMOXYTOL, ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00115-1694-30 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00115-1694-30 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00115-1694-30 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00781-3154-01 - PR FERUMOXYTOL, ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00115-1694-30 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00115-1694-30 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00781-3154-01 - PR FERUMOXYTOL, ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00597-0197-05 - PR UNCLASSIFIED DRUGS OR BIOLOG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00781-3154-01 - PR FERUMOXYTOL, ESRD USE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(402:402))),\"\" )","v":"00517-0901-25 - PR HYDRALAZINE HCL INJECTION"}]
["AARP UHC MEDICARE COMPLETE","00781-3206-95 - PR CEFTRIAXONE SODIUM INJECTION",null,null,{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(E$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(403:403))),\"\" )","v":"00781-3158-94 - PR BIVALIRUDIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(F$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(403:403))),\"\" )","v":"00115-1697-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(G$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(403:403))),\"\" )","v":"00781-3158-94 - PR BIVALIRUDIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(H$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(403:403))),\"\" )","v":"00517-0955-01 - PR INJ. 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PR INJ PACLITAXEL (AMERICAN REGENT)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00641-0928-21 - PR PROMETHAZINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00641-0928-21 - PR PROMETHAZINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00781-3466-70 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00904-2056-61 - PR DIPHENHYDRAMINE HCL 50MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00904-2056-61 - PR DIPHENHYDRAMINE HCL 50MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00121-0530-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00517-4300-01 - PR INJ PACLITAXEL (AMERICAN REGENT)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-89 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00116-2001-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00641-0928-21 - PR PROMETHAZINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(414:414))),\"\" )","v":"00517-4300-01 - PR INJ PACLITAXEL (AMERICAN REGENT)"}]
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PR INJ HEPARIN SODIUM PER 10 U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(465:465))),\"\" )","v":"09999-4050-46 - PR INJ HEPARIN SODIUM PER 10 U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(465:465))),\"\" )","v":"09999-4006-05 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(465:465))),\"\" )","v":"09999-4050-46 - PR INJ HEPARIN SODIUM PER 10 U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(465:465))),\"\" )","v":"09999-9995-25 - PR BEVACIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(465:465))),\"\" )","v":"09999-9995-25 - PR BEVACIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(465:465))),\"\" )","v":"00131-2478-60 - 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PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(473:473))),\"\" )","v":"12496-0300-01 - PR BUPRENORPHINE XR OVER 100 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(473:473))),\"\" )","v":"12496-0300-01 - PR BUPRENORPHINE XR OVER 100 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(473:473))),\"\" )","v":"00132-0202-20 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(473:473))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(473:473))),\"\" )","v":"00132-0202-20 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(473:473))),\"\" )","v":"12496-0300-01 - 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PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00703-5747-11 - PR CISPLATIN 10 MG INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00703-5747-11 - PR CISPLATIN 10 MG INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00132-0301-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"12496-0300-01 - PR BUPRENORPHINE XR OVER 100 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0107-08 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0109-16 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"14789-0109-16 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(474:474))),\"\" )","v":"00143-1171-01 - 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PR CAFFEINE CITRATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"25021-0601-03 - PR CAFFEINE CITRATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"25021-0502-01 - PR VITAMIN B12 INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"25021-0612-82 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"25021-0777-02 - PR ONDANSETRON HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"25021-0777-02 - PR ONDANSETRON HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"00168-0146-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"00168-0064-60 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"25021-0601-03 - PR CAFFEINE CITRATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"25021-0601-03 - PR CAFFEINE CITRATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"25021-0601-03 - PR CAFFEINE CITRATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"00168-0064-60 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(555:555))),\"\" )","v":"00955-1006-10 - 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PR NEOSTIGMINE METHYLSLFTE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(556:556))),\"\" )","v":"25021-0611-10 - PR NEOSTIGMINE METHYLSLFTE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(556:556))),\"\" )","v":"16729-0043-01 - PR TACROLIMUS ORAL PER 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(556:556))),\"\" )","v":"16729-0043-01 - PR TACROLIMUS ORAL PER 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(556:556))),\"\" )","v":"25021-0611-10 - PR NEOSTIGMINE METHYLSLFTE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(556:556))),\"\" )","v":"00168-0080-31 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(556:556))),\"\" )","v":"00168-0080-31 - 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PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0612-82 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"16729-0094-01 - PR MYCOPHENOLATE MOFETIL ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"16729-0094-01 - PR MYCOPHENOLATE MOFETIL ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0612-82 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"00168-0099-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"00168-0099-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"00168-0099-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"00168-0099-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"00168-0099-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0612-82 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"00168-0099-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"00168-0099-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0612-82 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0612-82 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0611-10 - PR NEOSTIGMINE METHYLSLFTE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0777-02 - PR ONDANSETRON HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0806-01 - PR HALOPERIDOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"25021-0806-01 - PR HALOPERIDOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(557:557))),\"\" )","v":"00168-0202-30 - 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PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"25021-0612-82 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"25021-0801-66 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"25021-0814-30 - PR LEUCOVORIN CALCIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"25021-0814-30 - PR LEUCOVORIN CALCIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"00168-0277-40 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"00168-0146-30 - 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PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"25021-0701-01 - PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"00168-0146-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"25021-0806-01 - PR HALOPERIDOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"00168-0146-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"25021-0701-01 - PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(558:558))),\"\" )","v":"00168-0146-30 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(559:559))),\"\" )","v":"00168-0163-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(559:559))),\"\" )","v":"00168-0163-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(559:559))),\"\" )","v":"00168-0163-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(559:559))),\"\" )","v":"25021-0777-02 - PR ONDANSETRON HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(559:559))),\"\" )","v":"00168-0163-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(559:559))),\"\" )","v":"00168-0163-30 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(559:559))),\"\" )","v":"25021-0801-66 - 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PR HALOPERIDOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(560:560))),\"\" )","v":"25021-0801-66 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(560:560))),\"\" )","v":"25021-0777-02 - PR ONDANSETRON HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(560:560))),\"\" )","v":"25021-0814-30 - PR LEUCOVORIN CALCIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(560:560))),\"\" )","v":"25021-0816-30 - PR LEUCOVORIN CALCIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(560:560))),\"\" )","v":"25021-0816-30 - PR LEUCOVORIN CALCIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(560:560))),\"\" )","v":"00169-7201-01 - 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PR ONDANSETRON HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(570:570))),\"\" )","v":"31722-0832-60 - PR ORAL PRESCRIP DRUG NON CHEMO"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(570:570))),\"\" )","v":"31722-0681-47 - PR ORAL PRESCRIP DRUG NON CHEMO"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(570:570))),\"\" )","v":"36000-0046-24 - PR LEVOFLOXACIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(570:570))),\"\" )","v":"36000-0282-25 - PR FUROSEMIDE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(570:570))),\"\" )","v":"36000-0282-25 - PR FUROSEMIDE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(570:570))),\"\" )","v":"00173-0526-00 - 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PR CHEMOTHERAPY DRUG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(582:582))),\"\" )","v":"00173-0896-01 - PR CHEMOTHERAPY DRUG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(582:582))),\"\" )","v":"42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(582:582))),\"\" )","v":"23155-0473-31 - PR FUROSEMIDE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(582:582))),\"\" )","v":"42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(582:582))),\"\" )","v":"14789-0109-16 - PR INJ POTASSIUM CHLORIDE"}]
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PR PHENOBARBITAL SODIUM INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0214-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0214-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"00173-0898-03 - INJ, DOSTARLIMAB-GXLY, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0214-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"00173-0898-03 - INJ, DOSTARLIMAB-GXLY, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"23155-0473-32 - PR FUROSEMIDE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"23155-0473-32 - PR FUROSEMIDE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"00173-0898-03 - INJ, DOSTARLIMAB-GXLY, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"00173-0898-03 - 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PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"00185-0129-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"00173-0898-03 - INJ, DOSTARLIMAB-GXLY, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"42023-0189-01 - PR NEOSTIGMINE METHYLSLFTE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(583:583))),\"\" )","v":"00173-0898-03 - 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PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(587:587))),\"\" )","v":"42023-0237-10 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(587:587))),\"\" )","v":"42023-0221-10 - PR ERTAPENEM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(587:587))),\"\" )","v":"43066-0023-01 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(587:587))),\"\" )","v":"43598-0050-11 - PR THIAMINE HCL 100 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(587:587))),\"\" )","v":"43598-0050-11 - PR THIAMINE HCL 100 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(587:587))),\"\" )","v":"00187-0795-30 - 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["AARP UHC MEDICARE COMPLETE","43066-0023-01 - PR ROPIVACAINE HCL INJECTION",null,null,{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(E$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(F$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(G$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(H$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"15054-1120-04 - LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(I$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(J$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"15054-1120-04 - 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PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"25021-0106-10 - PR CEFTRIAXONE SODIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"25021-0106-10 - PR CEFTRIAXONE SODIUM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"43066-0023-01 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"43066-0023-01 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"00186-0777-39 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(588:588))),\"\" )","v":"15054-1120-04 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"00186-0777-60 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"00186-0777-60 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"43066-0023-01 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"00186-0777-60 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"00186-0777-60 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"43066-0023-10 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"43066-0023-01 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"43598-0050-11 - PR THIAMINE HCL 100 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"43598-0053-11 - PR INJ DESMOPRESSIN ACETATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"43598-0053-11 - PR INJ DESMOPRESSIN ACETATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"00187-3012-20 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(589:589))),\"\" )","v":"00186-0777-60 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(668:668))),\"\" )","v":"00338-0043-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(668:668))),\"\" )","v":"50242-0103-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(668:668))),\"\" )","v":"50242-0103-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(668:668))),\"\" )","v":"50242-0105-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(668:668))),\"\" )","v":"00338-0043-03 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(668:668))),\"\" )","v":"25021-0461-10 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(674:674))),\"\" )","v":"00338-0049-04 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(674:674))),\"\" )","v":"50242-0143-01 - PR TOCILIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(674:674))),\"\" )","v":"50242-0143-01 - PR TOCILIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(674:674))),\"\" )","v":"50242-0145-01 - PR INJECTION, PERTUZUMAB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(674:674))),\"\" )","v":"00338-0049-04 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(674:674))),\"\" )","v":"25021-0701-01 - 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PR OXYTOCIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51991-0735-99 - PR GRANISETRON HCL 1 MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51991-0735-99 - PR GRANISETRON HCL 1 MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51991-0735-99 - PR GRANISETRON HCL 1 MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"44206-0452-02 - PR HIZENTRA INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"44206-0452-02 - PR HIZENTRA INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51672-4091-03 - PR ONDANSETRON 1 MG, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51144-0050-01 - PR BRENTUXIMAB VEDOTIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51991-0735-99 - PR GRANISETRON HCL 1 MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"54288-0164-01 - PR CARBOPLATIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"54288-0164-01 - PR CARBOPLATIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0671-03 - PR INJ POTASSIUM CHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51672-4091-03 - PR ONDANSETRON 1 MG, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"42023-0116-02 - PR OXYTOCIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"54288-0103-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51991-0735-99 - PR GRANISETRON HCL 1 MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"00338-0511-41 - HC 636 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51672-4091-03 - PR ONDANSETRON 1 MG, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"44206-0452-02 - PR HIZENTRA INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"51672-4091-03 - PR ONDANSETRON 1 MG, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(701:701))),\"\" )","v":"42023-0116-02 - PR OXYTOCIN INJECTION"}]
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PR OXYTOCIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(702:702))),\"\" )","v":"54288-0103-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(702:702))),\"\" )","v":"54288-0103-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(702:702))),\"\" )","v":"00338-0519-09 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(702:702))),\"\" )","v":"54288-0103-01 - PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(702:702))),\"\" )","v":"00338-0519-09 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(702:702))),\"\" )","v":"51672-4091-03 - 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PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0685-07 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"44567-0620-01 - PR CALCIUM GLUCON (WG CRITICAL)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"44567-0620-01 - PR CALCIUM GLUCON (WG CRITICAL)"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0685-07 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0685-07 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0694-07 - PR PALONOSETRON HCL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0685-07 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0685-07 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55150-0117-20 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55150-0168-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55150-0168-30 - 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PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"42858-0867-06 - PR DRONABINOL 2.5MG ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0685-07 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0685-07 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55150-0125-02 - PR ONDANSETRON HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55111-0685-07 - PR ZOLDERONIC ACID 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"55150-0117-20 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(720:720))),\"\" )","v":"00338-1075-02 - 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PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(721:721))),\"\" )","v":"55111-0694-07 - PR PALONOSETRON HCL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(721:721))),\"\" )","v":"00338-1077-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(721:721))),\"\" )","v":"00338-1077-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(721:721))),\"\" )","v":"00338-1077-02 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(721:721))),\"\" )","v":"55150-0125-02 - PR ONDANSETRON HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(721:721))),\"\" )","v":"00338-1077-02 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(737:737))),\"\" )","v":"00378-0078-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(737:737))),\"\" )","v":"55150-0193-30 - PR ADENOSINE INJ 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(737:737))),\"\" )","v":"00378-0078-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(737:737))),\"\" )","v":"00378-0078-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(737:737))),\"\" )","v":"55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(737:737))),\"\" )","v":"55150-0193-30 - PR ADENOSINE INJ 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(737:737))),\"\" )","v":"55150-0193-30 - 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PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"55150-0245-52 - PR LEVOFLOXACIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"55150-0304-01 - PR DEXAMETHASONE SODIUM PHOS"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"55150-0304-01 - PR DEXAMETHASONE SODIUM PHOS"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"00378-0181-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"00378-0137-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"55150-0197-20 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"00378-0137-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(738:738))),\"\" )","v":"44087-3535-01 - 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PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"50242-0103-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"50242-0103-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3547-52 - 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PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"00378-3350-16 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(765:765))),\"\" )","v":"55513-0025-04 - 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PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"50242-0105-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"50242-0105-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3627-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"45963-0614-55 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"00378-3350-99 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"50242-0105-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"55513-0027-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(766:766))),\"\" )","v":"45963-0614-55 - PR IRINOTECAN INJECTION"}]
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PR DOXORUBIC HCL 10 MG VL CHEMO"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"00378-3404-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"00378-3404-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"55513-0027-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"55513-0027-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"50242-0135-01 - PR TOCILIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"50242-0135-01 - PR TOCILIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"55513-0027-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"00378-3404-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(767:767))),\"\" )","v":"00378-3404-93 - 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RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0224-01 - PR INJ. RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-4276-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0057-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0057-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"47335-0049-40 - PR DOXORUBICIN INJ 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0057-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0057-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0222-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0057-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0221-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"00378-3950-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"50242-0138-01 - PR TOCILIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(770:770))),\"\" )","v":"47335-0049-40 - PR DOXORUBICIN INJ 10MG"}]
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RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0326-01 - PR INJ. RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-4276-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"47335-0050-40 - PR DOXORUBICIN INJ 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0223-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0222-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"00378-3952-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"50242-0143-01 - PR TOCILIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(771:771))),\"\" )","v":"47335-0050-40 - PR DOXORUBICIN INJ 10MG"}]
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PR INJ, METRONIDAZOLE, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0223-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0223-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0223-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0111-01 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0112-01 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"00378-4105-91 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(772:772))),\"\" )","v":"47335-0993-01 - 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RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0546-10 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0546-10 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"00378-5430-35 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"00378-4276-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"00378-4276-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"47781-0355-11 - PR BUPRENORPHIN/NALOX UP TO 3MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"00378-4276-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0326-01 - PR INJ. 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RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"00378-4276-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"00378-4276-77 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"50242-0214-01 - PR OMALIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(773:773))),\"\" )","v":"47781-0355-11 - PR BUPRENORPHIN/NALOX UP TO 3MG"}]
["AARP UHC MEDICARE COMPLETE","55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG",null,null,{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(E$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(774:774))),\"\" )","v":"55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(F$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(774:774))),\"\" )","v":"00378-4276-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(G$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(774:774))),\"\" )","v":"55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(H$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(774:774))),\"\" )","v":"47781-0584-93 - PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(I$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(774:774))),\"\" )","v":"55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(J$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(774:774))),\"\" )","v":"47781-0584-93 - PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(774:774))),\"\" )","v":"55513-0326-01 - PR INJ. 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["AARP UHC MEDICARE COMPLETE","55513-0221-01 - PR ROMIPLOSTIM INJECTION",null,null,{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(E$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(F$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"00378-5185-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(G$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(H$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"47781-0588-46 - PR INJ MIDAZOLAM HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(I$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(J$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"47781-0588-46 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"00378-5185-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"00378-5185-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"00378-5185-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"00378-5185-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"00378-5185-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"00378-5185-93 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0221-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0530-10 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(775:775))),\"\" )","v":"55513-0730-01 - 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PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(777:777))),\"\" )","v":"55513-0222-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(777:777))),\"\" )","v":"55513-0222-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(777:777))),\"\" )","v":"55513-0710-01 - PR INJECTION DENOSUMAB 60MG/1ML SYRG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(777:777))),\"\" )","v":"55513-0924-01 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(777:777))),\"\" )","v":"55513-0924-01 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(777:777))),\"\" )","v":"00378-6173-01 - 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RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(779:779))),\"\" )","v":"55513-0224-01 - PR INJ. RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(779:779))),\"\" )","v":"00378-6172-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(779:779))),\"\" )","v":"55513-0924-01 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(779:779))),\"\" )","v":"00378-6172-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(779:779))),\"\" )","v":"55513-0224-01 - PR INJ. 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PR ADRENALIN EPINEPHRINE INJECT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(805:805))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(805:805))),\"\" )","v":"50242-0103-01 - INJ, POLATUZUMAB VEDOTIN 1MG"}]
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INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"59572-0711-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"59572-0711-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"59572-0711-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"54288-0164-01 - PR CARBOPLATIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"54288-0164-01 - PR CARBOPLATIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-52 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0820-52 - PR HEP B VACCINE,DIAL/IMMUNOSUP, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"59572-0711-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"59676-0302-01 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"59676-0302-01 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0413-96 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-52 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"50242-0105-01 - INJ, POLATUZUMAB VEDOTIN 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"59572-0775-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-43 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"59572-0711-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"00395-0049-12 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"58160-0842-52 - PR TDAP VACCINE >7 YO, IM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(806:806))),\"\" )","v":"54288-0164-01 - 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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(816:816))),\"\" )","v":"00404-6730-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(816:816))),\"\" )","v":"59676-0303-00 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(816:816))),\"\" )","v":"59676-0303-00 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(816:816))),\"\" )","v":"59676-0303-01 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(816:816))),\"\" )","v":"00404-6730-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(816:816))),\"\" )","v":"50242-0260-01 - PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(816:816))),\"\" )","v":"59676-0303-00 - 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PR METHYLPREDNISOLONE ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(826:826))),\"\" )","v":"59676-0340-01 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(826:826))),\"\" )","v":"59676-0320-04 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(826:826))),\"\" )","v":"59762-2198-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(826:826))),\"\" )","v":"59762-3060-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(826:826))),\"\" )","v":"59762-3060-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(826:826))),\"\" )","v":"00406-8315-62 - 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PR METHYLPREDNISOLONE ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(827:827))),\"\" )","v":"59746-0002-04 - PR METHYLPREDNISOLONE ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(827:827))),\"\" )","v":"55150-0116-20 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(827:827))),\"\" )","v":"55150-0116-20 - PR AMPICILLIN SULBACTAM 1.5 GM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(827:827))),\"\" )","v":"59746-0002-04 - PR METHYLPREDNISOLONE ORAL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(827:827))),\"\" )","v":"00406-5755-62 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(827:827))),\"\" )","v":"00406-5755-62 - 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PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"61703-0342-50 - PR PACLITAXEL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"61703-0339-56 - PR CARBOPLATIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"00409-1749-10 - 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PR PACLITAXEL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"61703-0342-50 - PR PACLITAXEL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"00409-1746-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"00409-1746-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"61703-0342-50 - PR PACLITAXEL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(885:885))),\"\" )","v":"00409-1746-10 - 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PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(886:886))),\"\" )","v":"61703-0349-09 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(886:886))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(886:886))),\"\" )","v":"55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(886:886))),\"\" )","v":"61703-0349-09 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(886:886))),\"\" )","v":"00409-1746-70 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(886:886))),\"\" )","v":"00409-1746-70 - 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PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0363-22 - PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0363-22 - PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - 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PR AFLIBERCEPT INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0363-22 - PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0349-09 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0363-22 - PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0363-22 - PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61755-0005-01 - PR AFLIBERCEPT INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"55150-0180-03 - PR AMIODARONE HCL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0363-22 - PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0363-22 - PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61703-0363-22 - PR OXALIPLATIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"00409-1749-10 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61755-0005-01 - PR AFLIBERCEPT INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"61755-0005-01 - PR AFLIBERCEPT INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(888:888))),\"\" )","v":"55150-0180-03 - PR AMIODARONE HCL"}]
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PR ADENOSINE INJ 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"00409-1752-50 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"00409-1752-50 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"61755-0005-01 - 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PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"00409-1752-50 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"61755-0005-01 - PR AFLIBERCEPT INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"61755-0005-01 - PR AFLIBERCEPT INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"61755-0008-01 - PR INJ., CEMIPLIMAB-RWLC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"00409-1752-50 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(889:889))),\"\" )","v":"55150-0193-01 - 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PR ADENOSINE INJ 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"62332-0751-50 - PR FLUOROURACIL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"62332-0751-50 - PR FLUOROURACIL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"00409-1778-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"62332-0751-50 - PR FLUOROURACIL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"00409-1778-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"61755-0008-01 - 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PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"00409-1778-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"61755-0008-01 - PR INJ., CEMIPLIMAB-RWLC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"61755-0008-01 - PR INJ., CEMIPLIMAB-RWLC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"00409-1778-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"55150-0193-30 - PR ADENOSINE INJ 1MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"61755-0008-01 - PR INJ., CEMIPLIMAB-RWLC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"61755-0008-01 - PR INJ., CEMIPLIMAB-RWLC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"00409-1778-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"00409-1778-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"61755-0008-01 - 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PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"55513-0222-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(890:890))),\"\" )","v":"55150-0193-30 - PR ADENOSINE INJ 1MG"}]
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PR INJ, ESMOLOL HCL, 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"55513-0223-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"55513-0223-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61755-0005-01 - PR AFLIBERCEPT INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"62856-0389-01 - PR INJECTION ERIBULIN MESYLATE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"62856-0389-01 - PR INJECTION ERIBULIN MESYLATE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"00409-1778-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"55513-0223-01 - PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(891:891))),\"\" )","v":"55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"}]
["AARP UHC MEDICARE COMPLETE","61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG",null,null,{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(E$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(F$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(G$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(H$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"55150-0197-20 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(I$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(J$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"55150-0197-20 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"55513-0224-01 - PR INJ. RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"55513-0224-01 - PR INJ. RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61755-0008-01 - PR INJ., CEMIPLIMAB-RWLC, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"62935-0221-04 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"62935-0221-04 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"55150-0197-20 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"62756-0529-40 - PR INJ DESMOPRESSIN ACETATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"00409-1893-01 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"55513-0224-01 - PR INJ. RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(892:892))),\"\" )","v":"55150-0197-20 - PR ROPIVACAINE HCL INJECTION"}]
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RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"55513-0326-01 - PR INJ. RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"62756-0529-40 - PR INJ DESMOPRESSIN ACETATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"62935-0223-05 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"62935-0223-05 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-2051-05 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"55150-0198-30 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"62856-0212-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - PR LORAZEPAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(893:893))),\"\" )","v":"00409-1985-30 - 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PR INJ. 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PR MEROPENEM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62856-0212-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62856-0212-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62856-0212-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"55513-0530-10 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"55513-0530-10 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62856-0212-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62935-0227-10 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62935-0227-10 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2051-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"55150-0207-20 - PR MEROPENEM"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62856-0215-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62856-0212-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"00409-2050-01 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"55513-0530-10 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(894:894))),\"\" )","v":"55150-0207-20 - PR MEROPENEM"}]
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PR BIVALIRUDIN"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(895:895))),\"\" )","v":"62856-0215-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(895:895))),\"\" )","v":"62856-0215-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(895:895))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(895:895))),\"\" )","v":"62856-0215-01 - PR INJ, LECANEMAB-IRMB, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(895:895))),\"\" )","v":"00409-2050-20 - PR INJ MAGNESIUM SULFATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(895:895))),\"\" )","v":"62064-0122-02 - 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PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"55513-0730-01 - PR INJECTION DENOSUMAB 60MG/1ML SYRG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"55513-0730-01 - PR INJECTION DENOSUMAB 60MG/1ML SYRG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"00409-2051-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"00409-2051-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"00409-2051-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"00409-2051-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"00409-2051-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"00409-2051-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"00409-2051-15 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62935-0221-04 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62935-0756-80 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"62935-0756-80 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(897:897))),\"\" )","v":"00409-2267-20 - 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PR LEVOFLOXACIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"62935-0227-10 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"62935-0227-10 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"00409-2222-01 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"62935-0227-10 - PR LEUPROLIDE ACETATE SUSPNSION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"00409-2222-01 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"62756-0529-40 - PR INJ DESMOPRESSIN ACETATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"62756-0529-40 - PR INJ DESMOPRESSIN ACETATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"55513-0924-01 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"55513-0924-01 - PR INJ, FILGRASTIM G-CSF 1MCG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"62756-0529-40 - PR INJ DESMOPRESSIN ACETATE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"00409-2222-01 - PR INJ HEPARIN SODIUM PER 1000U"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(899:899))),\"\" )","v":"00409-2222-01 - 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PR ETOPOSIDE 10 MG INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"00409-2723-01 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"00409-2596-05 - PR INJ MIDAZOLAM HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"63323-0044-01 - PR VITAMIN B12 INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"63323-0044-01 - PR VITAMIN B12 INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"63323-0047-01 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"00409-2596-05 - PR INJ MIDAZOLAM HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"55292-0702-55 - PR HEMIN, 1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"63323-0044-01 - PR VITAMIN B12 INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"63323-0044-01 - PR VITAMIN B12 INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"00409-2596-05 - PR INJ MIDAZOLAM HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"63323-0103-51 - PR CISPLATIN 10 MG INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(916:916))),\"\" )","v":"00409-2596-05 - 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PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(940:940))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(940:940))),\"\" )","v":"00409-3795-01 - PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(940:940))),\"\" )","v":"63323-0165-03 - PR DEXAMETHASONE SODIUM PHOS"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(940:940))),\"\" )","v":"63323-0165-03 - PR DEXAMETHASONE SODIUM PHOS"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(940:940))),\"\" )","v":"63323-0165-05 - PR DEXAMETHASONE SODIUM PHOS"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(940:940))),\"\" )","v":"00409-3795-01 - 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PR ROMIPLOSTIM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(941:941))),\"\" )","v":"63323-0262-11 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(941:941))),\"\" )","v":"63323-0262-11 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(941:941))),\"\" )","v":"00409-3795-19 - PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(941:941))),\"\" )","v":"63323-0262-11 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(941:941))),\"\" )","v":"00409-3795-19 - PR KETOROLAC TROMETHAMINE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(941:941))),\"\" )","v":"63323-0165-05 - 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RIABNI, 10 MG"}]
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RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(I$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0203-01 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(J$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"55513-0326-01 - PR INJ. RIABNI, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(K$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0278-10 - PR VINBLASTINE SULFATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(L$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0278-10 - PR VINBLASTINE SULFATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(M$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0278-10 - PR VINBLASTINE SULFATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0203-01 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0203-01 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"59676-0340-01 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"59676-0340-01 - PR EPOETIN ALFA, NON-ESRD"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0203-01 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0203-01 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0229-05 - PR INJ PROTAMINE SULFATE/10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0203-01 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0165-05 - PR DEXAMETHASONE SODIUM PHOS"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0278-10 - PR VINBLASTINE SULFATE INJ"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0286-35 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0286-35 - PR ROPIVACAINE HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4092-01 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0203-01 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0203-01 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"63323-0229-05 - PR INJ PROTAMINE SULFATE/10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"00409-4031-01 - PR MANNITOL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(943:943))),\"\" )","v":"55513-0326-01 - PR INJ. 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RIABNI, 10 MG"}]
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PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":"68001-0525-32 - PR FLUOROURACIL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":"68001-0480-35 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":"68001-0480-35 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":"68001-0480-35 - 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PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":"68001-0480-35 - PR IRINOTECAN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(3977:3977))),\"\" )","v":""}]
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HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(N$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4128:4128))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(O$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4128:4128))),\"\" )","v":"68382-0138-14 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(P$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4128:4128))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Q$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4128:4128))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(R$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4128:4128))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(S$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4128:4128))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(T$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4128:4128))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(U$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4128:4128))),\"\" )","v":"68382-0138-14 - 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PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(V$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(W$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(X$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Y$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(Z$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AF$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AG$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AH$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AI$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9997-26 - HC 250 SHELL"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AJ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AK$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AL$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AM$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AN$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AO$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AP$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AQ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AR$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AS$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AT$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AU$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AV$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AW$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AX$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AY$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(AZ$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BA$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":"99999-9996-47 - PR VANCOMYCIN HCL INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BB$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BC$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BD$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$144006, SMALL(IF(BE$1=$A$2:$A$144006, ROW($A$2:$A$144006)-ROW($A$2)+1), ROW(4821:4821))),\"\" )","v":""}]
["AETNA","63323-0489-17 - HC 250 SHELL"]
["AETNA","65162-0757-10 - HC 250 SHELL"]
["AETNA","67457-0855-00 - PR ADENOSINE INJ 1MG"]
["AETNA","68084-0119-01 - HC 250 SHELL"]
["AETNA","69238-1605-02 - HC 250 SHELL"]
["AETNA","70710-1010-02 - HC 250 SHELL"]
["AETNA","70860-0701-01 - PR KETOROLAC TROMETHAMINE INJ"]
["AETNA","87701-0126-89 - HC 250 SHELL"]
["AETNA","99999-9900-73 - HC 250 SHELL"]
["AETNA","99999-9999-03 - ACETYLCYSTEINE NON-COMP UNIT"]
["AETNA MEDICARE MANAGED","00338-0683-04 - PR INJ POTASSIUM CHLORIDE"]
["AETNA MEDICARE MANAGED","00409-2347-31 - PR INJ DOBUTAMINE HCL/250 MG"]
["AETNA MEDICARE MANAGED","00517-0901-25 - PR HYDRALAZINE HCL INJECTION"]
["AETNA MEDICARE MANAGED","36000-0046-24 - PR LEVOFLOXACIN INJECTION"]
["AETNA MEDICARE MANAGED","49401-0088-35 - PR BELIMUMAB INJECTION"]
["AETNA MEDICARE MANAGED","55513-0057-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AETNA MEDICARE MANAGED","63323-0474-00 - PR HALOPERIDOL INJECTION"]
["AETNA MEDICARE MANAGED","66733-0948-23 - PR CETUXIMAB INJECTION"]
["AETNA MEDICARE MANAGED","70121-1396-01 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["BCBS","00009-7686-04 - PR ALPROSTADIL FOR INJECTION"]
["BCBS","00074-5015-01 - PR INJ RISANKIZUMAB-RZAA 1 MG"]
["BCBS","00409-9735-01 - PR CEFEPIME HCL FOR INJECTION"]
["BCBS","00703-3213-01 - PR PACLITAXEL INJECTION"]
["BCBS","09999-1282-77 - PR FENTANYL CITRATE INJECITON"]
["BCBS","49281-0123-65 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["BCBS","54288-0103-01 - PR ADRENALIN EPINEPHRINE INJECT"]
["BCBS","63323-0012-03 - PR OXYTOCIN INJECTION"]
["BCBS","63323-0617-20 - PR INJ MILRINONE LACTATE / 5 MG"]
["BCBS","67457-0833-06 - PR INJECTION, FULPHILA"]
["BCBS","76204-0900-11 - PR LEVALBUTEROL NON-COMP UNIT"]
["BCBS MEDICARE MANAGED","00003-3734-13 - PR INJECTION, NIVOLUMAB"]
["BCBS MEDICARE MANAGED","00143-9504-01 - PR CISPLATIN 10 MG INJECTION"]
["BCBS MEDICARE MANAGED","00548-5701-00 - PR MEDROXYPROGESTERONE ACETATE"]
["BCBS MEDICARE MANAGED","00781-3206-95 - PR CEFTRIAXONE SODIUM INJECTION"]
["BCBS MEDICARE MANAGED","44567-0241-10 - PR CEFEPIME HCL FOR INJECTION"]
["BCBS MEDICARE MANAGED","55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"]
["BCBS MEDICARE MANAGED","60505-6196-00 - PR ERTAPENEM INJECTION"]
["BCBS MEDICARE MANAGED","67457-0220-00 - PR VISUALIZATION ADJUNCT"]
["BCBS MEDICARE MANAGED","68084-0918-95 - PR MYCOPHENOLIC ACID"]
["BCBS MEDICARE MANAGED","72266-0161-01 - PR OXALIPLATIN"]
["BCBS OUT OF STATE","00078-0883-61 - PR INJ CRIZANLIZUMAB-TMCA 5MG"]
["BCBS OUT OF STATE","00264-5535-32 - PR INJ, METRONIDAZOLE, 10 MG"]
["BCBS OUT OF STATE","00469-6501-89 - PR REGADENOSON INJECTION"]
["BCBS OUT OF STATE","00944-2512-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["BCBS OUT OF STATE","25021-0233-10 - PR OXALIPLATIN"]
["BCBS OUT OF STATE","55111-0680-11 - PR FONDAPARINUX SODIUM"]
["BCBS OUT OF STATE","55150-0319-01 - PR CHLORPROMAZINE HCL INJECTION"]
["BCBS OUT OF STATE","61703-0339-50 - PR CARBOPLATIN INJECTION"]
["BCBS OUT OF STATE","67457-0351-01 - PR AMPICILLIN 500 MG INJ"]
["BCBS OUT OF STATE","70121-1454-01 - PR MEROPENEM"]
["BCBS OUT OF STATE","75987-0130-15 - PR INJ. TERPOTUMUMAB-TRBW 10 MG"]
["CCA","00075-0624-30 - PR INJ ENOXAPARIN SODIUM"]
["CCA","00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["CCA","00409-6653-18 - PR INJ POTASSIUM CHLORIDE"]
["CCA","00944-2700-05 - PR GAMMAGARD LIQUID INJECTION"]
["CCA","44567-0210-10 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["CCA","59762-2198-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["CCA","63323-0286-09 - PR ROPIVACAINE HCL INJECTION"]
["CCA","63459-0348-04 - PR INJ., BENDEKA 1 MG"]
["CCA","70512-0843-01 - PR KETOROLAC TROMETHAMINE INJ"]
["CCA MEDICARE PREFERRED","00003-0315-05 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA MEDICARE PREFERRED","00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["CCA MEDICARE PREFERRED","00409-9093-35 - PR FENTANYL CITRATE INJECITON"]
["CCA MEDICARE PREFERRED","00944-2700-06 - PR GAMMAGARD LIQUID INJECTION"]
["CCA MEDICARE PREFERRED","44567-0702-25 - PR CEFTRIAXONE SODIUM INJECTION"]
["CCA MEDICARE PREFERRED","55150-0335-01 - PR CARBOPLATIN INJECTION"]
["CCA MEDICARE PREFERRED","59676-0320-04 - PR EPOETIN ALFA, NON-ESRD"]
["CCA MEDICARE PREFERRED","63323-0360-19 - PR INJ, CALCIUM GLUCONATE, NOS 10 MG"]
["CCA MEDICARE PREFERRED","69918-0901-10 - PR INJ DESMOPRESSIN ACETATE"]
["CCA MEDICARE PREFERRED","71288-0114-50 - PR GEMCITABINE HCL"]
["CIGNA","00054-0177-13 - PR BUPRENOPHONE ORAL 1 MG"]
["CIGNA","00069-1306-10 - PR INJ RETACRIT NON-ESRD USE"]
["CIGNA","00121-0595-30 - HC 250 SHELL"]
["CIGNA","00143-9982-01 - HC 250 SHELL"]
["CIGNA","00228-3154-03 - PR BUPRENORPHIN/NALOX UP TO 3MG"]
["CIGNA","00338-6045-37 - PR FLUCONAZOLE"]
["CIGNA","00409-4699-54 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["CIGNA","00409-9094-41 - PR FENTANYL CITRATE INJECITON"]
["CIGNA","00641-6125-25 - PR MORPHINE SULFATE INJECTION"]
["CIGNA","00781-2020-01 - HC 250 SHELL"]
["CIGNA","00944-2700-06 - PR GAMMAGARD LIQUID INJECTION"]
["CIGNA","13310-0153-07 - HC 250 SHELL"]
["CIGNA","16729-0306-10 - PR AZACITIDINE INJECTION"]
["CIGNA","27241-0159-19 - HC 250 SHELL"]
["CIGNA","42806-0757-60 - HC 250 SHELL"]
["CIGNA","44206-0454-04 - PR HIZENTRA INJECTION"]
["CIGNA","50268-0756-11 - HC 250 SHELL"]
["CIGNA","50458-0578-10 - HC 250 SHELL"]
["CIGNA","51079-0566-20 - HC 250 SHELL"]
["CIGNA","55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"]
["CIGNA","55566-2200-00 - PR INJ DESMOPRESSIN ACETATE"]
["CIGNA","59762-4910-01 - HC 250 SHELL"]
["CIGNA","60687-0619-11 - HC 250 SHELL"]
["CIGNA","61314-0203-15 - HC 250 SHELL"]
["CIGNA","62756-0712-86 - HC 250 SHELL"]
["CIGNA","64980-0281-01 - HC 250 SHELL"]
["CIGNA","64980-0504-48 - HC 250 SHELL"]
["CIGNA","68084-0045-01 - HC 250 SHELL"]
["CIGNA","68084-0722-11 - HC 250 SHELL"]
["CIGNA","68982-0261-81 - HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION"]
["CIGNA","70127-0100-10 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["CIGNA","71506-0028-59 - PR OXYTOCIN INJECTION"]
["CIGNA","80681-0071-00 - HC 250 SHELL"]
["CIGNA","99999-9996-10 - HC 250 SHELL"]
["CORRECTIONS","00009-7529-03 - PR IRINOTECAN INJECTION"]
["CORRECTIONS","00409-2305-17 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["CORRECTIONS","00517-0031-01 - PR VITAMIN B12 INJECTION"]
["CORRECTIONS","00944-2510-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["CORRECTIONS","25021-0402-10 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["CORRECTIONS","55111-0685-07 - PR ZOLDERONIC ACID 1MG"]
["CORRECTIONS","60219-1076-01 - PR AZATHIOPRINE ORAL 50MG"]
["CORRECTIONS","66658-0234-01 - PR UNCLASSIFIED BIOLOGICS"]
["CORRECTIONS","69452-0350-92 - PR GRANISETRON HCL 1 MG ORAL"]
["FALLON","00004-0298-09 - MYCOPHENOLATE MOFETIL 500 MG/15 ML IV (RECONSTITUTED VIAL)"]
["FALLON","00037-6822-10 - HC 250 SHELL"]
["FALLON","00069-4220-30 - HC 250 SHELL"]
["FALLON","00121-4839-05 - HC 250 SHELL"]
["FALLON","00169-4181-13 - HC 250 SHELL"]
["FALLON","00264-7510-00 - HC 250 SHELL"]
["FALLON","00409-0829-01 - AZTREONAM 1 GRAM SOLUTION FOR INJECTION"]
["FALLON","00409-3182-02 - HC 250 SHELL"]
["FALLON","00574-4160-35 - HC 250 SHELL"]
["FALLON","00641-2555-45 - PR PHENYTOIN SODIUM INJECTION"]
["FALLON","00832-0512-00 - HC 250 SHELL"]
["FALLON","00944-2815-01 - PR ALPHA 1 PROTEINASE INHIBITOR"]
["FALLON","13668-0133-01 - HC 250 SHELL"]
["FALLON","20555-0003-01 - HC 250 SHELL"]
["FALLON","36000-0047-24 - PR LEVOFLOXACIN INJECTION"]
["FALLON","42023-0114-10 - HC 250 SHELL"]
["FALLON","44567-0437-24 - PR LEVOFLOXACIN INJECTION"]
["FALLON","50268-0523-11 - HC 250 SHELL"]
["FALLON","51079-0206-20 - HC 250 SHELL"]
["FALLON","51672-4130-01 - HC 250 SHELL"]
["FALLON","55150-0273-25 - PR THIAMINE HCL 100 MG"]
["FALLON","57237-0212-30 - HC 250 SHELL"]
["FALLON","60687-0211-11 - HC 250 SHELL"]
["FALLON","61269-0220-41 - HC 250 SHELL"]
["FALLON","61314-0547-01 - HC 250 SHELL"]
["FALLON","63323-0526-03 - PR ARGATROBAN NONESRD USE 1MG"]
["FALLON","63739-0795-10 - HC 250 SHELL"]
["FALLON","67457-0340-00 - PR VANCOMYCIN HCL INJECTION"]
["FALLON","67457-0629-10 - PR EPTIFIBATIDE INJECTION"]
["FALLON","68084-0862-01 - HC 250 SHELL"]
["FALLON","70069-0301-01 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["FALLON","70954-0518-10 - HC 250 SHELL"]
["FALLON","78206-0145-01 - ETONOGESTREL IMPLANT SYSTEM"]
["FALLON","99999-9900-87 - HC 250 SHELL"]
["FALLON","99999-9996-36 - HC 250 SHELL"]
["FALLON MEDICARE MANAGED","00143-9744-10 - PR GRANISETRON HCL INJECTION"]
["FALLON MEDICARE MANAGED","00409-6729-24 - PR INJ MAGNESIUM SULFATE"]
["FALLON MEDICARE MANAGED","00517-2340-01 - PR IRON SUCROSE INJECTION"]
["FALLON MEDICARE MANAGED","25021-0235-50 - PR GEMCITABINE HCL"]
["FALLON MEDICARE MANAGED","50242-0044-06 - PR ALTEPLASE RECOMBINANT"]
["FALLON MEDICARE MANAGED","57894-0450-01 - TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION"]
["FALLON MEDICARE MANAGED","63323-0519-02 - PR INJ HEPARIN SODIUM PER 1000U"]
["FALLON MEDICARE MANAGED","66993-0730-51 - PR ORAL DEXAMETHASONE"]
["FALLON MEDICARE MANAGED","75987-0130-15 - PR INJ. TERPOTUMUMAB-TRBW 10 MG"]
["FALLON SCO","00054-4181-25 - PR ORAL DEXAMETHASONE"]
["FALLON SCO","00143-9505-01 - PR CISPLATIN 10 MG INJECTION"]
["FALLON SCO","00409-2308-02 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["FALLON SCO","00955-1010-10 - PR INJ ENOXAPARIN SODIUM"]
["FALLON SCO","31722-0832-60 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["FALLON SCO","55513-0954-01 - PANITUMUMAB INJECTION"]
["FALLON SCO","60505-6277-00 - PR CISPLATIN 10 MG INJECTION"]
["FALLON SCO","63323-0117-01 - PR FLUOROURACIL INJECTION"]
["FALLON SCO","70092-1125-48 - PR MORPHINE SULFATE INJECTION"]
["FALLON SCO","72266-0252-01 - PR CISPLATIN 10 MG INJECTION"]
["HARVARD PILGRIM HEALTH CARE","00009-5140-01 - PR LINEZOLID INJECTION"]
["HARVARD PILGRIM HEALTH CARE","00409-1163-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["HARVARD PILGRIM HEALTH CARE","00409-9094-12 - PR FENTANYL CITRATE INJECITON"]
["HARVARD PILGRIM HEALTH CARE","00641-6044-25 - PR LORAZEPAM INJECTION"]
["HARVARD PILGRIM HEALTH CARE","36000-0047-24 - PR LEVOFLOXACIN INJECTION"]
["HARVARD PILGRIM HEALTH CARE","50242-0214-01 - PR OMALIZUMAB INJECTION"]
["HARVARD PILGRIM HEALTH CARE","59676-0320-00 - PR EPOETIN ALFA, NON-ESRD"]
["HARVARD PILGRIM HEALTH CARE","63323-0162-01 - PR KETOROLAC TROMETHAMINE INJ"]
["HARVARD PILGRIM HEALTH CARE","65757-0300-01 - PR NALTREXONE, DEPOT FORM"]
["HARVARD PILGRIM HEALTH CARE","71288-0410-85 - PR INJ ENOXAPARIN SODIUM"]
["HARVARD PILGRIM HEALTH CARE","81298-5781-01 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HEALTH PLANS INC","00054-8175-25 - PR ORAL DEXAMETHASONE"]
["HEALTH PLANS INC","00409-2308-21 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["HEALTH PLANS INC","00548-5701-00 - PR MEDROXYPROGESTERONE ACETATE"]
["HEALTH PLANS INC","25021-0227-06 - PR ARSENIC TRIOXIDE"]
["HEALTH PLANS INC","43598-0053-11 - PR INJ DESMOPRESSIN ACETATE"]
["HEALTH PLANS INC","51991-0735-99 - PR GRANISETRON HCL 1 MG ORAL"]
["HEALTH PLANS INC","62756-0529-40 - PR INJ DESMOPRESSIN ACETATE"]
["HEALTH PLANS INC","63323-0376-00 - PR OCTREOTIDE INJ, NON-DEPOT"]
["HEALTH PLANS INC","68462-0756-01 - PR KETOROLAC TROMETHAMINE INJ"]
["HEALTH PLANS INC","72485-0101-01 - PR DIPHENHYDRAMINE HCL INJECTIO"]
["HPHC MEDICARE MANAGED","00009-0825-01 - PR HYDROCORTISONE SODIUM SUCC I"]
["HPHC MEDICARE MANAGED","00409-2308-02 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["HPHC MEDICARE MANAGED","00409-7337-11 - PR CEFTRIAXONE SODIUM INJECTION"]
["HPHC MEDICARE MANAGED","00944-2511-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["HPHC MEDICARE MANAGED","49281-0123-88 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HPHC MEDICARE MANAGED","55513-0025-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["HPHC MEDICARE MANAGED","61703-0363-18 - PR OXALIPLATIN"]
["HPHC MEDICARE MANAGED","65757-0402-03 - PR INJECTION, ARIPIPRAZOLE LAUROXIL, (ARISTADA), 1 MG"]
["HPHC MEDICARE MANAGED","70092-1099-49 - PR FENTANYL CITRATE INJECITON"]
["HSN","00004-0038-22 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["HSN","00008-4117-01 - HC 250 SHELL"]
["HSN","00069-3140-19 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["HSN","00121-0868-05 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN","00168-0146-30 - HC 250 SHELL"]
["HSN","00338-0003-44 - HC 250 SHELL"]
["HSN","00409-0182-01 - PR GEMCITABINE HCL"]
["HSN","00409-4888-50 - HC 250 SHELL"]
["HSN","00436-0936-16 - HC 250 SHELL"]
["HSN","00574-0827-10 - PR INJ TESTOSTERONE CYPIONATE"]
["HSN","00781-8028-01 - HC 250 SHELL"]
["HSN","00944-2814-01 - PR ALPHA 1 PROTEINASE INHIBITOR"]
["HSN","13668-0045-01 - HC 250 SHELL"]
["HSN","19515-0814-41 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HSN","35573-0433-30 - HC 250 SHELL"]
["HSN","43066-0008-01 - HC 250 SHELL"]
["HSN","44567-0420-00 - PR INJ MAGNESIUM SULFATE"]
["HSN","50268-0102-11 - HC 250 SHELL"]
["HSN","51079-0165-01 - HC 250 SHELL"]
["HSN","51991-0819-01 - HC 250 SHELL"]
["HSN","55150-0242-51 - PR LINEZOLID INJECTION"]
["HSN","55513-0222-01 - PR ROMIPLOSTIM INJECTION"]
["HSN","60687-0163-11 - HC 250 SHELL"]
["HSN","60687-0661-01 - HC 250 SHELL"]
["HSN","61314-0354-01 - HC 250 SHELL"]
["HSN","63323-0508-30 - PR MEROPENEM"]
["HSN","63459-0104-50 - PR INJ TRUXIMA 10 MG"]
["HSN","67457-0228-05 - HC 250 SHELL"]
["HSN","68084-0185-11 - HC 250 SHELL"]
["HSN","68084-0790-25 - HC 250 SHELL"]
["HSN","69374-0979-30 - PR MORPHINE SULFATE INJECTION"]
["HSN","70954-0148-10 - HC 250 SHELL"]
["HSN","71546-4552-50 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["HSN","99999-9900-78 - HC 250 SHELL"]
["HSN","99999-9965-90 - HC 250 SHELL"]
["HSN BAD DEBT","00054-0018-29 - PR PREDNISONE IR OR DR ORAL 1MG"]
["HSN BAD DEBT","00074-2625-28 - HC 250 SHELL"]
["HSN BAD DEBT","00093-0318-01 - HC 250 SHELL"]
["HSN BAD DEBT","00132-0201-42 - HC 250 SHELL"]
["HSN BAD DEBT","00310-4535-30 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"]
["HSN BAD DEBT","00338-3410-50 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN BAD DEBT","00409-6729-24 - PR INJ MAGNESIUM SULFATE"]
["HSN BAD DEBT","00409-7332-11 - PR CEFTRIAXONE SODIUM INJECTION"]
["HSN BAD DEBT","00536-1241-81 - HC 250 SHELL"]
["HSN BAD DEBT","00904-0530-61 - HC 250 SHELL"]
["HSN BAD DEBT","00904-6551-61 - PR ONDANSETRON 1 MG, ORAL"]
["HSN BAD DEBT","00990-7074-26 - PR INJ POTASSIUM CHLORIDE"]
["HSN BAD DEBT","23155-0227-01 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["HSN BAD DEBT","25021-0173-02 - PR AMIKACIN SULFATE INJECTION"]
["HSN BAD DEBT","36000-0012-25 - PR ONDANSETRON HCL INJECTION"]
["HSN BAD DEBT","47335-0684-83 - HC 250 SHELL"]
["HSN BAD DEBT","49884-0724-01 - PR ORAL PRESCRIPTION DRUG CHEMO"]
["HSN BAD DEBT","51079-0386-20 - HC 250 SHELL"]
["HSN BAD DEBT","51079-0810-20 - HC 250 SHELL"]
["HSN BAD DEBT","51754-4250-03 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN BAD DEBT","57894-0501-00 - AMIVANTAMAB-VMJW 50 MG/ML INTRAVENOUS SOLUTION"]
["HSN BAD DEBT","59676-0570-01 - HC 250 SHELL"]
["HSN BAD DEBT","60687-0188-11 - HC 250 SHELL"]
["HSN BAD DEBT","61958-2101-01 - HC 250 SHELL"]
["HSN BAD DEBT","63323-0047-01 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["HSN BAD DEBT","64253-0222-25 - PR INJ HEPARIN SODIUM PER 10 U"]
["HSN BAD DEBT","65597-0406-01 - PR INJ FAM-TRASTU DERU-NXKI 1MG"]
["HSN BAD DEBT","68001-0524-29 - PR FLUOROURACIL INJECTION"]
["HSN BAD DEBT","68094-0764-62 - HC 250 SHELL"]
["HSN BAD DEBT","69238-2081-01 - HC 250 SHELL"]
["HSN BAD DEBT","70069-0030-01 - PR HALOPERIDOL DECANOATE INJ"]
["HSN BAD DEBT","72319-0006-02 - HC 250 SHELL"]
["HSN BAD DEBT","87701-0425-67 - HC 250 SHELL"]
["HSN BAD DEBT","99999-9997-33 - HC 636 SHELL"]
["HSN CONFIDENTIAL","00002-7678-01 - PR CHEMOTHERAPY DRUG"]
["HSN CONFIDENTIAL","00054-0019-25 - PR PREDNISONE IR OR DR ORAL 1MG"]
["HSN CONFIDENTIAL","00093-3109-53 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00121-4839-05 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00143-9856-01 - PR CEFTRIAXONE SODIUM INJECTION"]
["HSN CONFIDENTIAL","00378-1030-77 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00395-0413-96 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00517-2325-10 - PR IRON SUCROSE INJECTION"]
["HSN CONFIDENTIAL","00555-0071-02 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00641-6057-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["HSN CONFIDENTIAL","00904-6559-61 - HC 250 SHELL"]
["HSN CONFIDENTIAL","08065-1831-35 - HC 250 SHELL"]
["HSN CONFIDENTIAL","11845-0091-51 - HC 250 SHELL"]
["HSN CONFIDENTIAL","25021-0402-10 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["HSN CONFIDENTIAL","42292-0001-01 - HC 250 SHELL"]
["HSN CONFIDENTIAL","42702-0103-05 - HC 250 SHELL"]
["HSN CONFIDENTIAL","50242-0085-25 - PR ALTEPLASE RECOMBINANT"]
["HSN CONFIDENTIAL","50268-0678-15 - HC 250 SHELL"]
["HSN CONFIDENTIAL","51079-0685-20 - HC 250 SHELL"]
["HSN CONFIDENTIAL","53489-0145-01 - HC 250 SHELL"]
["HSN CONFIDENTIAL","55150-0169-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["HSN CONFIDENTIAL","59762-3060-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["HSN CONFIDENTIAL","60687-0431-99 - HC 250 SHELL"]
["HSN CONFIDENTIAL","60687-0586-01 - HC 250 SHELL"]
["HSN CONFIDENTIAL","63323-0147-10 - HC 250 SHELL"]
["HSN CONFIDENTIAL","63323-0466-37 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["HSN CONFIDENTIAL","64980-0236-01 - HC 250 SHELL"]
["HSN CONFIDENTIAL","67457-0440-22 - PR ONDANSETRON HCL INJECTION"]
["HSN CONFIDENTIAL","68001-0480-35 - PR IRINOTECAN INJECTION"]
["HSN CONFIDENTIAL","69097-0709-30 - PR VITAMIN K PHYTONADIONE INJ"]
["HSN CONFIDENTIAL","70121-1579-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["HSN CONFIDENTIAL","70860-0211-41 - PR INJECTION, FULVESTRANT"]
["HSN CONFIDENTIAL","99990-9942-37 - HC 250 SHELL"]
["HSN CONFIDENTIAL","99999-9369-62 - HC 250 SHELL"]
["HSN CONFIDENTIAL","99999-9997-42 - HC 250 SHELL"]
["HSN DENTAL","00054-0622-63 - HC 250 SHELL"]
["HSN DENTAL","00069-4061-89 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["HSN DENTAL","00093-2210-05 - HC 250 SHELL"]
["HSN DENTAL","00143-9873-25 - HC 250 SHELL"]
["HSN DENTAL","00264-4460-30 - HC 250 SHELL"]
["HSN DENTAL","00409-2050-20 - PR INJ MAGNESIUM SULFATE"]
["HSN DENTAL","00409-4928-11 - HC 250 SHELL"]
["HSN DENTAL","00574-4144-35 - HC 250 SHELL"]
["HSN DENTAL","00641-6126-01 - PR MORPHINE SULFATE INJECTION"]
["HSN DENTAL","00832-0038-89 - HC 250 SHELL"]
["HSN DENTAL","00904-6671-04 - HC 250 SHELL"]
["HSN DENTAL","13668-0094-90 - HC 250 SHELL"]
["HSN DENTAL","23155-0473-42 - PR FUROSEMIDE INJECTION"]
["HSN DENTAL","42023-0104-01 - HC 250 SHELL"]
["HSN DENTAL","43066-0023-10 - PR ROPIVACAINE HCL INJECTION"]
["HSN DENTAL","45963-0438-64 - HC 250 SHELL"]
["HSN DENTAL","50268-0570-11 - HC 250 SHELL"]
["HSN DENTAL","51079-0205-01 - HC 250 SHELL"]
["HSN DENTAL","51079-0929-20 - HC 250 SHELL"]
["HSN DENTAL","55150-0273-01 - PR THIAMINE HCL 100 MG"]
["HSN DENTAL","57664-0135-65 - HC 250 SHELL"]
["HSN DENTAL","59762-3080-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["HSN DENTAL","60687-0670-11 - HC 250 SHELL"]
["HSN DENTAL","61958-2401-01 - HC 250 SHELL"]
["HSN DENTAL","63323-0326-20 - PR CEFEPIME HCL FOR INJECTION"]
["HSN DENTAL","63739-0591-10 - HC 250 SHELL"]
["HSN DENTAL","65862-0202-90 - HC 250 SHELL"]
["HSN DENTAL","68084-0214-11 - HC 250 SHELL"]
["HSN DENTAL","68084-0602-11 - PR PERPHENAZINE 4MG ORAL"]
["HSN DENTAL","69097-0709-96 - PR VITAMIN K PHYTONADIONE INJ"]
["HSN DENTAL","70954-0484-20 - HC 250 SHELL"]
["HSN DENTAL","73625-0114-11 - HC 250 SHELL"]
["HSN DENTAL","99990-9996-27 - PR VANCOMYCIN HCL INJECTION"]
["HSN DENTAL","99999-9996-33 - HC 250 SHELL"]
["HSN PARTIAL","00004-0298-09 - MYCOPHENOLATE MOFETIL 500 MG/15 ML IV (RECONSTITUTED VIAL)"]
["HSN PARTIAL","00074-3473-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["HSN PARTIAL","00093-3174-31 - HC 250 SHELL"]
["HSN PARTIAL","00121-1154-00 - HC 250 SHELL"]
["HSN PARTIAL","00338-0004-02 - HC 250 SHELL"]
["HSN PARTIAL","00378-5813-77 - HC 250 SHELL"]
["HSN PARTIAL","00409-1587-50 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["HSN PARTIAL","00487-9801-01 - PR IPRATROPIUM BROMIDE NON-COMP"]
["HSN PARTIAL","00574-4160-35 - HC 250 SHELL"]
["HSN PARTIAL","00904-1883-61 - HC 250 SHELL"]
["HSN PARTIAL","00904-6592-04 - HC 250 SHELL"]
["HSN PARTIAL","00944-3053-02 - PR FACTOR VIII RECOMBINANT NOS"]
["HSN PARTIAL","23155-0290-41 - PR AMIKACIN SULFATE INJECTION"]
["HSN PARTIAL","25682-0025-01 - PR RAVULIZUMAB-CWVZ"]
["HSN PARTIAL","43598-0220-40 - HC 250 SHELL"]
["HSN PARTIAL","45802-0811-00 - HC 250 SHELL"]
["HSN PARTIAL","49938-0102-30 - HC 250 SHELL"]
["HSN PARTIAL","51079-0417-20 - HC 250 SHELL"]
["HSN PARTIAL","51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["HSN PARTIAL","52817-0210-10 - HC 250 SHELL"]
["HSN PARTIAL","57896-0454-01 - HC 250 SHELL"]
["HSN PARTIAL","60505-0080-00 - HC 250 SHELL"]
["HSN PARTIAL","60687-0211-11 - HC 250 SHELL"]
["HSN PARTIAL","61570-0131-50 - HC 250 SHELL"]
["HSN PARTIAL","63323-0064-02 - PR INJ MAGNESIUM SULFATE"]
["HSN PARTIAL","64253-0900-30 - HC 250 SHELL"]
["HSN PARTIAL","65862-0751-50 - HC 250 SHELL"]
["HSN PARTIAL","67457-0163-02 - HC 250 SHELL"]
["HSN PARTIAL","68176-0000-10 - HC 250 SHELL"]
["HSN PARTIAL","69238-2093-03 - HC 250 SHELL"]
["HSN PARTIAL","70069-0301-01 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["HSN PARTIAL","71546-0082-05 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["HSN PARTIAL","87701-0432-33 - HC 250 SHELL"]
["HSN PARTIAL","99999-9997-49 - HC 250 SHELL"]
["HUMANA MEDICARE","00069-0315-01 - PR INJ., ZIRABEV, 10 MG"]
["HUMANA MEDICARE","00409-2305-16 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["HUMANA MEDICARE","00409-2723-02 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["HUMANA MEDICARE","09999-9995-25 - PR BEVACIZUMAB INJECTION"]
["HUMANA MEDICARE","25021-0235-50 - PR GEMCITABINE HCL"]
["HUMANA MEDICARE","51079-0518-01 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["HUMANA MEDICARE","61314-0318-05 - PR INJECTION, ZARXIO"]
["HUMANA MEDICARE","67457-0426-00 - PR HALOPERIDOL INJECTION"]
["HUMANA MEDICARE","70860-0127-51 - PR PENICILLIN G POTASSIUM INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00002-4464-30 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00006-3603-61 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00074-4552-11 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00093-1060-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00121-4820-15 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00338-0023-03 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00409-1631-10 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00409-7517-66 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00536-1202-15 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00591-0844-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00904-5309-20 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00904-6596-04 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","16729-0136-00 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","25021-0173-02 - PR AMIKACIN SULFATE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","27241-0160-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","43598-0447-70 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","45802-0650-87 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","50102-0111-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","51079-0443-20 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","51079-0883-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","52817-0210-10 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","59572-0102-01 - PR AZACITIDINE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","60505-0791-00 - PR INJ ENOXAPARIN SODIUM"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","60758-0119-05 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","61958-0501-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","63323-0523-01 - PR INJ HEPARIN SODIUM PER 1000U"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","64679-0012-02 - PR PIPERACILLIN/TAZOBACTAM"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","66220-0207-30 - PR ACETYLCYSTEINE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","67457-0410-00 - PR HALOPERIDOL DECANOATE INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","68180-0659-07 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","69339-0148-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","71288-0803-21 - MYCOPHENOLATE MOFETIL 500 MG/15 ML IV (RECONSTITUTED VIAL)"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","72611-0734-01 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99999-9369-62 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99999-9997-80 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00009-5140-01 - PR LINEZOLID INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00054-0235-24 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00093-2027-23 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00143-1171-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00338-0206-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00378-3125-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00409-3815-12 - PR IN MORPHINE PRESERVATIV FREE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00521-2384-00 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00597-0152-30 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00641-6127-25 - PR MORPHINE SULFATE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00904-6502-61 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","09994-0900-39 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","24208-0730-06 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","31722-0530-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","42023-0237-10 - PR INJ, VASOPRESSIN, 1 UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","46122-0575-78 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","50242-0214-01 - PR OMALIZUMAB INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","50268-0787-11 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","51079-0966-20 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","55111-0680-11 - PR FONDAPARINUX SODIUM"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","55150-0207-20 - PR MEROPENEM"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","60505-3277-00 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","60687-0390-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","61314-0355-02 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","63323-0203-01 - PR VANCOMYCIN HCL INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","63323-0483-57 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","65862-0535-13 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","67877-0219-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","68084-0097-11 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","69452-0151-20 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","70436-0051-06 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","71399-4456-05 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99994-0801-47 - PR AMPICILLIN 500 MG INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99999-9900-63 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99999-9997-84 - HC 250 SHELL"]
["MEDICARE","00310-4505-25 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"]
["MEDICARE","00409-2308-21 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["MEDICARE","18657-0117-04 - PR HYALURONIDASE RECOMBINANT"]
["MEDICARE","36000-0283-25 - PR FUROSEMIDE INJECTION"]
["MEDICARE","50242-0260-01 - PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN"]
["MEDICARE","63261-0250-21 - PR VISUALIZATION ADJUNCT"]
["MEDICARE","63323-0466-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["MEDICARE","67457-0833-06 - PR INJECTION, FULPHILA"]
["MEDICARE","76014-0004-30 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["NEIGHBORHOOD PACE","00049-0014-83 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["NEIGHBORHOOD PACE","00409-9094-31 - PR FENTANYL CITRATE INJECITON"]
["NEIGHBORHOOD PACE","00641-6061-25 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["NEIGHBORHOOD PACE","25021-0173-04 - PR AMIKACIN SULFATE INJECTION"]
["NEIGHBORHOOD PACE","51754-5060-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["NEIGHBORHOOD PACE","55513-0221-01 - PR ROMIPLOSTIM INJECTION"]
["NEIGHBORHOOD PACE","62332-0751-50 - PR FLUOROURACIL INJECTION"]
["NEIGHBORHOOD PACE","65757-0402-03 - PR INJECTION, ARIPIPRAZOLE LAUROXIL, (ARISTADA), 1 MG"]
["NEIGHBORHOOD PACE","70121-1754-01 - PR INJ ALYMSYS 10 MG"]
["OXFORD HEALTH","00078-0790-61 - PR OCTREOTIDE INJECTION, DEPOT"]
["OXFORD HEALTH","00338-0077-04 - PR 5% DEXTROSE/NORMAL SALINE"]
["OXFORD HEALTH","00409-9094-28 - PR FENTANYL CITRATE INJECITON"]
["OXFORD HEALTH","16729-0472-30 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["OXFORD HEALTH","31722-0681-47 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["OXFORD HEALTH","50268-0787-12 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["OXFORD HEALTH","62935-0221-04 - PR LEUPROLIDE ACETATE SUSPNSION"]
["OXFORD HEALTH","63323-0365-01 - PR OCTREOTIDE INJ, NON-DEPOT"]
["OXFORD HEALTH","67457-0528-10 - PR LEUCOVORIN CALCIUM INJECTION"]
["OXFORD HEALTH","99994-0801-47 - PR AMPICILLIN 500 MG INJ"]
["SENIOR WHOLE HEALTH","00074-3641-03 - PR LEUPROLIDE ACETATE /3.75 MG"]
["SENIOR WHOLE HEALTH","00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["SENIOR WHOLE HEALTH","00641-6044-25 - PR LORAZEPAM INJECTION"]
["SENIOR WHOLE HEALTH","16729-0042-01 - PR TACROLIMUS ORAL PER 1 MG"]
["SENIOR WHOLE HEALTH","51754-0500-01 - PR CAFFEINE CITRATE INJECTION"]
["SENIOR WHOLE HEALTH","59676-0304-00 - PR EPOETIN ALFA, NON-ESRD"]
["SENIOR WHOLE HEALTH","61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["SENIOR WHOLE HEALTH","67979-0511-43 - PR TESTOSTERONE UNDECANOATE 1MG"]
["SENIOR WHOLE HEALTH","71288-0113-10 - PR GEMCITABINE HCL"]
["SENIOR WHOLE HEALTH","99999-9996-47 - PR VANCOMYCIN HCL INJECTION"]
["TRICARE EAST","00338-0077-03 - PR 5% DEXTROSE/NORMAL SALINE"]
["TRICARE EAST","00409-7335-03 - PR CEFTRIAXONE SODIUM INJECTION"]
["TRICARE EAST","16729-0500-30 - PR FUROSEMIDE INJECTION"]
["TRICARE EAST","43598-0050-11 - PR THIAMINE HCL 100 MG"]
["TRICARE EAST","51079-0519-01 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["TRICARE EAST","63323-0024-25 - PR MANNITOL INJECTION"]
["TRICARE EAST","63833-0615-02 - HUMATE-P, INJ"]
["TRICARE EAST","68001-0524-28 - PR FLUOROURACIL INJECTION"]
["TRICARE FOR LIFE","00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"]
["TRICARE FOR LIFE","00078-0386-66 - PR MYCOPHENOLIC ACID"]
["TRICARE FOR LIFE","00469-0871-30 - PR ADENOSINE INJ 1MG"]
["TRICARE FOR LIFE","00641-6061-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["TRICARE FOR LIFE","16729-0332-03 - PR OXALIPLATIN"]
["TRICARE FOR LIFE","55111-0526-01 - PR TACROLIMUS ORAL PER 1 MG"]
["TRICARE FOR LIFE","59762-4440-03 - PR METHYLPREDNISOLONE ORAL"]
["TRICARE FOR LIFE","64980-0509-24 - PR ORAL DEXAMETHASONE"]
["TRICARE FOR LIFE","70114-0101-01 - PR INJECTION, UDENYCA, 0.5 MG"]
["TRICARE FOR LIFE","71288-0808-77 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["TUFTS","00046-1102-81 - HC 250 SHELL"]
["TUFTS","00054-0390-63 - HC 250 SHELL"]
["TUFTS","00078-0818-81 - PR OCTREOTIDE INJECTION, DEPOT"]
["TUFTS","00143-9680-01 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["TUFTS","00264-7578-10 - PR MANNITOL INJECTION"]
["TUFTS","00404-6512-05 - HC 250 SHELL"]
["TUFTS","00409-5820-01 - PR DOPAMINE INJECTION"]
["TUFTS","00469-0520-02 - HC 250 SHELL"]
["TUFTS","00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"]
["TUFTS","00904-5790-61 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["TUFTS","00904-6376-61 - HC 250 SHELL"]
["TUFTS","00944-2514-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["TUFTS","20555-0040-00 - HC 250 SHELL"]
["TUFTS","25021-0106-10 - PR CEFTRIAXONE SODIUM INJECTION"]
["TUFTS","39328-0064-12 - HC 250 SHELL"]
["TUFTS","44567-0620-24 - PR CALCIUM GLUCON (WG CRITICAL)"]
["TUFTS","50268-0561-15 - HC 250 SHELL"]
["TUFTS","51079-0246-01 - HC 250 SHELL"]
["TUFTS","51672-1289-02 - HC 250 SHELL"]
["TUFTS","51754-5060-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS","57664-0394-88 - HC 250 SHELL"]
["TUFTS","59676-0302-00 - PR EPOETIN ALFA, NON-ESRD"]
["TUFTS","60687-0226-11 - HC 250 SHELL"]
["TUFTS","61314-0643-05 - HC 250 SHELL"]
["TUFTS","63323-0424-05 - HC 250 SHELL"]
["TUFTS","63739-0988-32 - HC 250 SHELL"]
["TUFTS","65862-0678-01 - HC 250 SHELL"]
["TUFTS","67457-0162-02 - HC 250 SHELL"]
["TUFTS","68084-0948-95 - HC 250 SHELL"]
["TUFTS","68462-0406-01 - HC 250 SHELL"]
["TUFTS","71139-0012-01 - PR OXYTOCIN INJECTION"]
["TUFTS","72205-0101-07 - INJ, BUMETANIDE, 0.5 MG"]
["TUFTS","83257-0004-12 - HC 636 SHELL"]
["TUFTS","99999-9996-81 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00004-0800-85 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00049-4910-30 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00093-1078-53 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00115-4411-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00264-7578-10 - PR MANNITOL INJECTION"]
["TUFTS CONNCARE/QHP","00378-0181-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00409-1163-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["TUFTS CONNCARE/QHP","00517-0901-01 - PR HYDRALAZINE HCL INJECTION"]
["TUFTS CONNCARE/QHP","00555-0159-02 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00641-6019-10 - PR IN MORPHINE PRESERVATIV FREE"]
["TUFTS CONNCARE/QHP","00904-6617-61 - PR HYDROXYZINE PAMOATE 25MG"]
["TUFTS CONNCARE/QHP","01108-4228-91 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","16729-0276-38 - PR FLUOROURACIL INJECTION"]
["TUFTS CONNCARE/QHP","25021-0245-04 - PR DOCETAXEL INJECTION"]
["TUFTS CONNCARE/QHP","37864-0000-33 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","45802-0730-30 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","48433-0108-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","50268-0582-15 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","51079-0888-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","52817-0360-10 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","55150-0116-20 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["TUFTS CONNCARE/QHP","59746-0325-30 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","60687-0273-11 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","61958-0602-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","62856-0212-01 - PR INJ, LECANEMAB-IRMB, 1 MG"]
["TUFTS CONNCARE/QHP","63323-0733-11 - PR MESNA INJECTION"]
["TUFTS CONNCARE/QHP","65862-0062-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","67457-0423-00 - PR DEXAMETHASONE SODIUM PHOS"]
["TUFTS CONNCARE/QHP","68001-0433-90 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","68462-0235-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","70092-1452-44 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","72627-2501-03 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["TUFTS CONNCARE/QHP","99940-8011-36 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","99999-9900-99 - HC 250 SHELL"]
["TUFTS MEDICARE","00009-7376-11 - PR MEDROXYPROGESTERONE ACETATE"]
["TUFTS MEDICARE","00264-4204-52 - PR INJ MAGNESIUM SULFATE"]
["TUFTS MEDICARE","00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["TUFTS MEDICARE","00641-6125-25 - PR MORPHINE SULFATE INJECTION"]
["TUFTS MEDICARE","25021-0451-01 - PR OCTREOTIDE INJ, NON-DEPOT"]
["TUFTS MEDICARE","55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["TUFTS MEDICARE","61703-0349-09 - PR IRINOTECAN INJECTION"]
["TUFTS MEDICARE","63323-0411-25 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["TUFTS MEDICARE","70092-1485-46 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["TUFTS MEDICARE","81284-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["TUFTS MEDICARE MANAGED","00003-2327-11 - PR IPILIMUMAB INJECTION"]
["TUFTS MEDICARE MANAGED","00173-0898-03 - INJ, DOSTARLIMAB-GXLY, 10 MG"]
["TUFTS MEDICARE MANAGED","00641-1410-35 - PR DIGOXIN INJECTION"]
["TUFTS MEDICARE MANAGED","00904-5307-60 - PR DIPHENHYDRAMINE HCL 50MG"]
["TUFTS MEDICARE MANAGED","50242-0917-01 - PR INJ, ATEZOLIZUMAB,10 MG"]
["TUFTS MEDICARE MANAGED","55150-0245-52 - PR LEVOFLOXACIN INJECTION"]
["TUFTS MEDICARE MANAGED","63323-0373-02 - PR ONDANSETRON HCL INJECTION"]
["TUFTS MEDICARE MANAGED","67457-0423-00 - PR DEXAMETHASONE SODIUM PHOS"]
["TUFTS MEDICARE MANAGED","69918-0901-10 - PR INJ DESMOPRESSIN ACETATE"]
["TUFTS MEDICARE MANAGED","99999-9997-63 - PR MORPHINE SULFATE INJECTION"]
["UBH HPHC","00143-9875-01 - PR AMIODARONE HCL"]
["UBH HPHC","00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UBH HPHC","14789-0107-08 - PR INJ POTASSIUM CHLORIDE"]
["UBH HPHC","23155-0473-44 - PR FUROSEMIDE INJECTION"]
["UBH HPHC","55513-0021-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["UBH HPHC","61703-0339-22 - PR CARBOPLATIN INJECTION"]
["UBH HPHC","63323-0286-11 - PR ROPIVACAINE HCL INJECTION"]
["UBH HPHC","67457-0220-00 - PR VISUALIZATION ADJUNCT"]
["UBH HPHC","72266-0118-01 - PR KETOROLAC TROMETHAMINE INJ"]
["UNICARE","00002-7349-01 - HC 637 SHELL"]
["UNICARE","00074-7126-11 - HC 250 SHELL"]
["UNICARE","00093-2064-06 - HC 250 SHELL"]
["UNICARE","00143-9555-01 - PR LEUCOVORIN CALCIUM INJECTION"]
["UNICARE","00338-0049-38 - HC 250 SHELL"]
["UNICARE","00378-0871-99 - HC 250 SHELL"]
["UNICARE","00409-1208-11 - HC 250 SHELL"]
["UNICARE","00409-9558-05 - HC 250 SHELL"]
["UNICARE","00548-5701-00 - PR MEDROXYPROGESTERONE ACETATE"]
["UNICARE","00904-5823-60 - HC 250 SHELL"]
["UNICARE","00904-6663-61 - HC 250 SHELL"]
["UNICARE","09994-0900-57 - HC 250 SHELL"]
["UNICARE","24201-0201-01 - HC 250 SHELL"]
["UNICARE","25021-0312-02 - HC 250 SHELL"]
["UNICARE","37864-0860-01 - HC 250 SHELL"]
["UNICARE","43598-0486-27 - HC 250 SHELL"]
["UNICARE","49401-0088-35 - PR BELIMUMAB INJECTION"]
["UNICARE","51079-0455-20 - HC 250 SHELL"]
["UNICARE","51079-0925-20 - HC 250 SHELL"]
["UNICARE","53329-0087-01 - HC 250 SHELL"]
["UNICARE","58468-0090-01 - PR SYNVISC OR SYNVISC-ONE"]
["UNICARE","59762-2198-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["UNICARE","60687-0309-11 - HC 250 SHELL"]
["UNICARE","62584-0812-01 - HC 250 SHELL"]
["UNICARE","63323-0120-20 - PR CYTARABINE HCL 100 MG INJ"]
["UNICARE","63323-0464-31 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UNICARE","65862-0146-36 - HC 250 SHELL"]
["UNICARE","67457-0217-20 - PR METHADONE INJECTION"]
["UNICARE","68180-0659-07 - HC 250 SHELL"]
["UNICARE","69097-0517-07 - PR CYCLOPHOSPHAMIDE ORAL 25 MG"]
["UNICARE","70121-1049-02 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNICARE","76204-0022-60 - PR STERILE WATER/SALINE, 10 ML"]
["UNICARE","99980-9988-12 - HC 250 SHELL"]
["UNICARE","99999-9291-60 - HC 250 SHELL"]
["UNITED","00009-3701-05 - PR ALPROSTADIL FOR INJECTION"]
["UNITED","00069-4494-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"]
["UNITED","00409-9094-41 - PR FENTANYL CITRATE INJECITON"]
["UNITED","00703-0241-01 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED","00990-7074-26 - PR INJ POTASSIUM CHLORIDE"]
["UNITED","47781-0355-11 - PR BUPRENORPHIN/NALOX UP TO 3MG"]
["UNITED","51754-5060-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNITED","57894-0450-01 - TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION"]
["UNITED","63323-0540-11 - PR INJ HEPARIN SODIUM PER 1000U"]
["UNITED","67457-0629-10 - PR EPTIFIBATIDE INJECTION"]
["UNITED","76045-0737-01 - PR HALOPERIDOL INJECTION"]
["UNITED COMMUNITY PLAN","00049-0530-28 - PR PENICILLIN G POTASSIUM INJ"]
["UNITED COMMUNITY PLAN","00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"]
["UNITED COMMUNITY PLAN","00517-2340-10 - PR IRON SUCROSE INJECTION"]
["UNITED COMMUNITY PLAN","00641-6125-25 - PR MORPHINE SULFATE INJECTION"]
["UNITED COMMUNITY PLAN","25021-0107-20 - PR CEFTRIAXONE SODIUM INJECTION"]
["UNITED COMMUNITY PLAN","55150-0170-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UNITED COMMUNITY PLAN","60505-6132-06 - PR OXALIPLATIN"]
["UNITED COMMUNITY PLAN","64253-0222-25 - PR INJ HEPARIN SODIUM PER 10 U"]
["UNITED COMMUNITY PLAN","70127-0100-10 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["UNITED COMMUNITY PLAN","72205-0101-01 - INJ, BUMETANIDE, 0.5 MG"]
["UNITED MEDICARE MANAGED","00143-9510-01 - PR ETOPOSIDE 10 MG INJ"]
["UNITED MEDICARE MANAGED","00409-7337-01 - PR CEFTRIAXONE SODIUM INJECTION"]
["UNITED MEDICARE MANAGED","00517-0032-25 - PR VITAMIN B12 INJECTION"]
["UNITED MEDICARE MANAGED","00944-2512-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["UNITED MEDICARE MANAGED","49281-0400-10 - PR TDAP VACCINE >7 YO, IM"]
["UNITED MEDICARE MANAGED","58160-0842-43 - PR TDAP VACCINE >7 YO, IM"]
["UNITED MEDICARE MANAGED","63323-0464-31 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UNITED MEDICARE MANAGED","65757-0403-03 - PR INJECTION, ARIPIPRAZOLE LAUROXIL, (ARISTADA), 1 MG"]
["UNITED MEDICARE MANAGED","72266-0253-01 - PR CISPLATIN 10 MG INJECTION"]
["UPHAMS CORNER ESP","00006-5423-12 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00025-2742-31 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00069-3150-83 - PR AZITHROMYCIN"]
["UPHAMS CORNER ESP","00121-0873-16 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00173-0547-00 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00378-4276-77 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00409-0183-01 - PR GEMCITABINE HCL"]
["UPHAMS CORNER ESP","00487-9601-01 - PR BUDESONIDE NON-COMP UNIT"]
["UPHAMS CORNER ESP","00574-0820-01 - PR INJ TESTOSTERONE CYPIONATE"]
["UPHAMS CORNER ESP","00641-1398-31 - PR CHLORPROMAZINE HCL INJECTION"]
["UPHAMS CORNER ESP","00781-8034-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00944-2815-01 - PR ALPHA 1 PROTEINASE INHIBITOR"]
["UPHAMS CORNER ESP","13533-0606-12 - PR ANTITHROMBIN III INJECTION"]
["UPHAMS CORNER ESP","25021-0826-82 - PR ZOLDERONIC ACID 1MG"]
["UPHAMS CORNER ESP","35573-0443-25 - PR LEVALBUTEROL NON-COMP UNIT"]
["UPHAMS CORNER ESP","43066-0008-10 - HC 250 SHELL"]
["UPHAMS CORNER ESP","49884-0724-01 - PR ORAL PRESCRIPTION DRUG CHEMO"]
["UPHAMS CORNER ESP","50268-0858-15 - HC 250 SHELL"]
["UPHAMS CORNER ESP","51079-0197-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","51991-0820-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","55111-0527-01 - PR TACROLIMUS ORAL PER 1 MG"]
["UPHAMS CORNER ESP","59762-3060-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["UPHAMS CORNER ESP","60687-0178-11 - HC 250 SHELL"]
["UPHAMS CORNER ESP","60687-0661-11 - HC 250 SHELL"]
["UPHAMS CORNER ESP","63323-0047-01 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["UPHAMS CORNER ESP","63323-0464-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UPHAMS CORNER ESP","63739-0572-10 - HC 250 SHELL"]
["UPHAMS CORNER ESP","67457-0228-10 - HC 250 SHELL"]
["UPHAMS CORNER ESP","68084-0202-11 - HC 250 SHELL"]
["UPHAMS CORNER ESP","68682-0652-20 - HC 250 SHELL"]
["UPHAMS CORNER ESP","70069-0013-01 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["UPHAMS CORNER ESP","70954-0151-10 - HC 250 SHELL"]
["UPHAMS CORNER ESP","87701-0425-67 - HC 250 SHELL"]
["UPHAMS CORNER ESP","99999-4081-96 - PR ALBUTEROL NON-COMP CON"]
["UPHAMS CORNER ESP","99999-9996-31 - HC 250 SHELL"]
["WELLCARE","00143-9702-01 - PR IRINOTECAN INJECTION"]
["WELLCARE","00409-2720-32 - HEPARIN (PORCINE) 1 000 UNIT/ML INJECTION SOLUTION"]
["WELLCARE","00703-3986-01 - PR OXALIPLATIN"]
["WELLCARE","25021-0233-20 - PR OXALIPLATIN"]
["WELLCARE","50242-0070-01 - PR OBINUTUZUMAB INJ"]
["WELLCARE","61314-0326-10 - PR INJECTION, ZARXIO"]
["WELLCARE","63323-0064-01 - PR INJ MAGNESIUM SULFATE"]
["WELLCARE","67457-0182-00 - PR INJ, ESMOLOL HCL, 10MG"]
["WELLCARE","76075-0101-01 - PR INJECTION, CARFILZOMIB, 1 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00006-4309-01 - HC 636 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00054-3630-63 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00093-1172-01 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00121-1882-11 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00338-0048-04 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00378-3547-52 - PR ORAL PRESCRIPTION DRUG CHEMO"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00409-1163-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00517-0901-25 - PR HYDRALAZINE HCL INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00591-3221-26 - PR INJ TESTOSTERO ENANTHATE 1MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00641-6126-25 - PR MORPHINE SULFATE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00904-6620-61 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","01490-0039-04 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","23155-0661-42 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","27434-0010-17 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","41100-0811-22 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","45802-0732-00 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","50242-0040-62 - PR OMALIZUMAB INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","50268-0594-15 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","51079-0926-01 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","52817-0361-10 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","58160-0842-43 - PR TDAP VACCINE >7 YO, IM"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","60505-0815-00 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","60687-0293-01 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","61958-0701-01 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","63323-0117-01 - PR FLUOROURACIL INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","63323-0462-37 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","65219-0570-04 - INJ, BUMETANIDE, 0.5 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","67457-0423-12 - PR DEXAMETHASONE SODIUM PHOS"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","68001-0438-16 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","69367-0323-16 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","70010-0051-40 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","72682-2625-00 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99940-8011-44 - HC 636 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99999-9116-30 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99999-9999-53 - HC 250 SHELL"]
["WELLSENSE MEDICARE MANAGED","00264-5535-32 - PR INJ, METRONIDAZOLE, 10 MG"]
["WELLSENSE MEDICARE MANAGED","00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["WELLSENSE MEDICARE MANAGED","16729-0041-01 - PR TACROLIMUS ORAL PER 1 MG"]
["WELLSENSE MEDICARE MANAGED","19515-0814-52 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["WELLSENSE MEDICARE MANAGED","50242-0137-01 - PR TOCILIZUMAB INJECTION"]
["WELLSENSE MEDICARE MANAGED","61703-0363-18 - PR OXALIPLATIN"]
["WELLSENSE MEDICARE MANAGED","63323-0355-60 - PR LEVOFLOXACIN INJECTION"]
["WELLSENSE MEDICARE MANAGED","67457-0857-30 - PR ADENOSINE INJ 1MG"]
["WELLSENSE MEDICARE MANAGED","81284-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["WORKERS COMP","00003-0293-20 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WORKERS COMP","00075-0622-80 - PR INJ ENOXAPARIN SODIUM"]
["WORKERS COMP","00116-2001-89 - HC 250 SHELL"]
["WORKERS COMP","00131-2477-60 - HC 250 SHELL"]
["WORKERS COMP","00338-0072-25 - PR KETOROLAC TROMETHAMINE INJ"]
["WORKERS COMP","00378-1049-01 - HC 250 SHELL"]
["WORKERS COMP","00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["WORKERS COMP","00517-2340-10 - PR IRON SUCROSE INJECTION"]
["WORKERS COMP","00555-0159-02 - HC 250 SHELL"]
["WORKERS COMP","00904-5959-61 - HC 250 SHELL"]
["WORKERS COMP","00904-7047-61 - HC 250 SHELL"]
["WORKERS COMP","08290-3064-14 - PR INJ HEPARIN SODIUM PER 10 U"]
["WORKERS COMP","24208-0342-05 - HC 250 SHELL"]
["WORKERS COMP","25021-0410-77 - PR INJ ENOXAPARIN SODIUM"]
["WORKERS COMP","39328-0063-25 - HC 250 SHELL"]
["WORKERS COMP","43598-0262-11 - PR INJECTION, FULVESTRANT"]
["WORKERS COMP","50242-0087-01 - PR INJ, ADO-TRASTUZUMAB EMT 1MG"]
["WORKERS COMP","51079-0499-01 - HC 250 SHELL"]
["WORKERS COMP","51079-0930-01 - HC 250 SHELL"]
["WORKERS COMP","52565-0014-80 - HC 250 SHELL"]
["WORKERS COMP","58980-0409-12 - HC 250 SHELL"]
["WORKERS COMP","59762-3140-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["WORKERS COMP","60687-0333-11 - HC 250 SHELL"]
["WORKERS COMP","62559-0153-04 - HC 250 SHELL"]
["WORKERS COMP","63323-0162-01 - PR KETOROLAC TROMETHAMINE INJ"]
["WORKERS COMP","63323-0469-01 - PR HALOPERIDOL DECANOATE INJ"]
["WORKERS COMP","65862-0202-99 - HC 250 SHELL"]
["WORKERS COMP","67457-0153-00 - PR AMIODARONE HCL"]
["WORKERS COMP","68382-0005-14 - HC 250 SHELL"]
["WORKERS COMP","69374-0559-30 - HC 636 SHELL"]
["WORKERS COMP","70121-1573-05 - PR METHYLPRED ACETATE 1 MG INJ"]
["WORKERS COMP","73625-0114-11 - HC 250 SHELL"]
["WORKERS COMP","99990-9944-99 - PR OXYTOCIN INJECTION"]
["WORKERS COMP","99999-9408-02 - HC 250 SHELL"]
["ZZZAETNA","00004-0800-85 - HC 250 SHELL"]
["ZZZAETNA","00069-5800-43 - HC 250 SHELL"]
["ZZZAETNA","00093-5060-01 - HC 250 SHELL"]
["ZZZAETNA","00143-9254-25 - PR DOPAMINE INJECTION"]
["ZZZAETNA","00169-7201-01 - PR FACTOR VIIA"]
["ZZZAETNA","00378-1030-93 - HC 250 SHELL"]
["ZZZAETNA","00409-2051-15 - HC 250 SHELL"]
["ZZZAETNA","00409-4933-11 - PR ADRENALIN EPINEPHRINE INJECT"]
["ZZZAETNA","00574-7034-12 - HC 250 SHELL"]
["ZZZAETNA","00781-3315-70 - PR OXALIPLATIN"]
["ZZZAETNA","00904-6868-61 - HC 250 SHELL"]
["ZZZAETNA","09999-1289-36 - PR MORPHINE SULFATE INJECTION"]
["ZZZAETNA","13668-0453-01 - HC 250 SHELL"]
["ZZZAETNA","25021-0173-04 - PR AMIKACIN SULFATE INJECTION"]
["ZZZAETNA","42023-0113-10 - HC 250 SHELL"]
["ZZZAETNA","43066-0997-01 - HC 250 SHELL"]
["ZZZAETNA","50268-0102-11 - HC 250 SHELL"]
["ZZZAETNA","50474-0770-09 - HC 250 SHELL"]
["ZZZAETNA","51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["ZZZAETNA","54838-0005-30 - HC 250 SHELL"]
["ZZZAETNA","55150-0304-01 - PR DEXAMETHASONE SODIUM PHOS"]
["ZZZAETNA","60505-0112-00 - HC 250 SHELL"]
["ZZZAETNA","60687-0549-11 - HC 250 SHELL"]
["ZZZAETNA","60687-0672-65 - HC 250 SHELL"]
["ZZZAETNA","61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"]
["ZZZAETNA","63323-0533-01 - PR INJ ENOXAPARIN SODIUM"]
["ZZZAETNA","65162-0686-88 - HC 250 SHELL"]
["ZZZAETNA","67877-0198-05 - HC 250 SHELL"]
["ZZZAETNA","68084-0220-11 - PR ONDANSETRON 1 MG, ORAL"]
["ZZZAETNA","69238-2094-03 - HC 250 SHELL"]
["ZZZAETNA","70700-0268-99 - HC 250 SHELL"]
["ZZZAETNA","70954-0518-10 - HC 250 SHELL"]
["ZZZAETNA","75834-0159-05 - HC 250 SHELL"]
["ZZZAETNA","99999-9900-88 - HC 250 SHELL"]
["ZZZAETNA","99999-9998-50 - HC 250 SHELL"]
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["ZZZBU EMPLOYEE WORK COMP","00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["ZZZBU EMPLOYEE WORK COMP","00093-5526-06 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00172-4097-60 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00338-0013-04 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00378-6172-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00409-7335-03 - PR CEFTRIAXONE SODIUM INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","00517-2502-10 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00781-1874-31 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00904-2085-60 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00904-6907-06 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","12870-0001-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","23155-0473-31 - PR FUROSEMIDE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","27241-0062-03 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","43598-0262-02 - PR INJECTION, FULVESTRANT"]
["ZZZBU EMPLOYEE WORK COMP","49281-0423-88 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["ZZZBU EMPLOYEE WORK COMP","50474-0770-09 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","51079-0436-20 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","51293-0616-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","55111-0681-11 - PR FONDAPARINUX SODIUM"]
["ZZZBU EMPLOYEE WORK COMP","57896-0629-12 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","60505-0114-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","60687-0758-11 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","62584-0265-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","63323-0692-10 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZBU EMPLOYEE WORK COMP","64281-0113-00 - HC 636 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","65862-0840-03 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","68084-0381-11 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","68084-0907-21 - PR MYCOPHENOLIC ACID"]
["ZZZBU EMPLOYEE WORK COMP","69315-0116-10 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","71288-0436-91 - PR INJ ENOXAPARIN SODIUM"]
["ZZZBU EMPLOYEE WORK COMP","76329-8261-01 - PR LORAZEPAM INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","99999-1646-20 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","99999-9997-51 - HC 250 SHELL"]
["ZZZCCA ONECARE","00069-0809-01 - PR INJECTION, INFLECTRA"]
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["ZZZCCA ONECARE","00641-6228-25 - PR THIAMINE HCL 100 MG"]
["ZZZCCA ONECARE","10019-0120-01 - PR INJ, ESMOLOL HCL, 10MG"]
["ZZZCCA ONECARE","50474-0700-62 - CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT"]
["ZZZCCA ONECARE","59338-0775-01 - PR FERUMOXYTOL, ESRD USE"]
["ZZZCCA ONECARE","63323-0012-10 - PR OXYTOCIN INJECTION"]
["ZZZCCA ONECARE","67457-0617-30 - PR GEMCITABINE HCL"]
["ZZZCCA ONECARE","70860-0406-10 - INJ, BUMETANIDE, 0.5 MG"]
["ZZZCIGNA","00013-5301-17 - HC 250 SHELL"]
["ZZZCIGNA","00054-3185-44 - HC 250 SHELL"]
["ZZZCIGNA","00074-7069-11 - HC 250 SHELL"]
["ZZZCIGNA","00143-9086-01 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["ZZZCIGNA","00225-0525-47 - HC 250 SHELL"]
["ZZZCIGNA","00338-0067-01 - PR DOXORUBICIN INJ 10MG"]
["ZZZCIGNA","00409-3724-11 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCIGNA","00409-9042-16 - HC 250 SHELL"]
["ZZZCIGNA","00603-1542-15 - HC 250 SHELL"]
["ZZZCIGNA","00641-6060-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["ZZZCIGNA","00904-5790-61 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["ZZZCIGNA","09994-0900-55 - HC 250 SHELL"]
["ZZZCIGNA","16729-0225-16 - HC 250 SHELL"]
["ZZZCIGNA","29300-0168-15 - HC 250 SHELL"]
["ZZZCIGNA","42571-0162-01 - HC 250 SHELL"]
["ZZZCIGNA","43598-0561-78 - HC 250 SHELL"]
["ZZZCIGNA","50268-0069-11 - HC 250 SHELL"]
["ZZZCIGNA","50268-0523-15 - HC 250 SHELL"]
["ZZZCIGNA","51079-0455-01 - HC 250 SHELL"]
["ZZZCIGNA","54288-0167-01 - PR CARBOPLATIN INJECTION"]
["ZZZCIGNA","55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"]
["ZZZCIGNA","60219-1749-03 - HC 250 SHELL"]
["ZZZCIGNA","60505-2528-06 - HC 250 SHELL"]
["ZZZCIGNA","60793-0700-10 - PR PENICILLIN G BENZATHINE INJ"]
["ZZZCIGNA","61958-1501-01 - HC 250 SHELL"]
["ZZZCIGNA","63323-0965-10 - PR INJ POTASSIUM CHLORIDE"]
["ZZZCIGNA","63739-0901-28 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["ZZZCIGNA","66302-0664-01 - HC 250 SHELL"]
["ZZZCIGNA","68084-0536-11 - HC 250 SHELL"]
["ZZZCIGNA","68180-0659-07 - HC 250 SHELL"]
["ZZZCIGNA","70000-0173-65 - HC 250 SHELL"]
["ZZZCIGNA","71351-0013-99 - HC 250 SHELL"]
["ZZZCIGNA","73535-0208-01 - TAFASITAMAB-CXIX 200 MG/5 ML IV (RECONSTITUTED VIAL)"]
["ZZZCIGNA","99999-9994-92 - PR CEFTRIAXONE SODIUM INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","00004-0800-85 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00016-0316-60 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00078-0696-20 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00093-4175-73 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00143-9335-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["ZZZCITY OF BOSTON WORK COMP","00338-0357-03 - PR MANNITOL INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","00378-4105-91 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00436-0672-16 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00555-0159-02 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00603-1542-58 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00904-6322-61 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00904-6828-94 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","08627-0078-01 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["ZZZCITY OF BOSTON WORK COMP","24338-0230-05 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","31722-0631-31 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","44567-0400-10 - PR MEROPENEM"]
["ZZZCITY OF BOSTON WORK COMP","48433-0108-01 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","50268-0086-11 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","51079-0632-01 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","51079-0991-20 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","55513-0006-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["ZZZCITY OF BOSTON WORK COMP","59390-0190-50 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","60505-6128-00 - PR IRINOTECAN INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","61314-0326-10 - PR INJECTION, ZARXIO"]
["ZZZCITY OF BOSTON WORK COMP","62332-0385-30 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","63323-0276-02 - HEPARIN  PORCINE (PF) 1 000 UNIT/ML INJECTION SOLUTION"]
["ZZZCITY OF BOSTON WORK COMP","65162-0442-10 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","66993-0068-51 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","68084-0220-11 - PR ONDANSETRON 1 MG, ORAL"]
["ZZZCITY OF BOSTON WORK COMP","68455-0106-90 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","69547-0353-02 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","70515-0262-10 - PR DIGOXIN INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","76329-3012-05 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","99999-9900-99 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","99999-9999-54 - HC 250 SHELL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","00121-0978-10 - PR DIPHENHYDRAMINE HCL 50MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","00338-0704-34 - PR INJ POTASSIUM CHLORIDE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","00641-6125-25 - PR MORPHINE SULFATE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","23155-0473-32 - PR FUROSEMIDE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","57894-0160-01 - PR INFLIXIMAB INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","63323-0412-13 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","68084-0450-11 - PR TACROLIMUS ORAL PER 1 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","71546-0080-05 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","99999-9342-70 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["ZZZHEALTH PLANS INC","00143-9398-01 - PR ERTAPENEM INJECTION"]
["ZZZHEALTH PLANS INC","00409-4520-02 - PR INJ HEPARIN SODIUM PER 1000U"]
["ZZZHEALTH PLANS INC","00517-0720-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZHEALTH PLANS INC","25021-0806-01 - PR HALOPERIDOL INJECTION"]
["ZZZHEALTH PLANS INC","49401-0088-01 - PR BELIMUMAB INJECTION"]
["ZZZHEALTH PLANS INC","59572-0102-01 - PR AZACITIDINE INJECTION"]
["ZZZHEALTH PLANS INC","63323-0104-25 - PR ETOPOSIDE 10 MG INJ"]
["ZZZHEALTH PLANS INC","63323-0526-03 - PR ARGATROBAN NONESRD USE 1MG"]
["ZZZHEALTH PLANS INC","68001-0525-27 - PR FLUOROURACIL INJECTION"]
["ZZZHEALTH PLANS INC","76329-3318-01 - PR ADRENALIN EPINEPHRINE INJECT"]
["ZZZRAILROAD MEDICARE","00003-0293-05 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZRAILROAD MEDICARE","00409-4755-18 - PR ONDANSETRON HCL INJECTION"]
["ZZZRAILROAD MEDICARE","00641-1495-35 - PR PROMETHAZINE HCL INJECTION"]
["ZZZRAILROAD MEDICARE","25021-0461-10 - PR INJ DESMOPRESSIN ACETATE"]
["ZZZRAILROAD MEDICARE","50242-0138-01 - PR TOCILIZUMAB INJECTION"]
["ZZZRAILROAD MEDICARE","55150-0273-01 - PR THIAMINE HCL 100 MG"]
["ZZZRAILROAD MEDICARE","63323-0276-02 - HEPARIN  PORCINE (PF) 1 000 UNIT/ML INJECTION SOLUTION"]
["ZZZRAILROAD MEDICARE","67457-0352-02 - PR AMPICILLIN 500 MG INJ"]
["ZZZRAILROAD MEDICARE","69374-0979-30 - PR MORPHINE SULFATE INJECTION"]
["ZZZRAILROAD MEDICARE","72485-0504-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["ZZZUNITED","00078-0385-66 - PR MYCOPHENOLIC ACID"]
["ZZZUNITED","00270-1316-35 - LOCM 300-399MG/ML IODINE,1ML"]
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["ZZZUNITED","00944-2700-11 - PR GAMMAGARD LIQUID INJECTION"]
["ZZZUNITED","42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"]
["ZZZUNITED","55150-0116-20 - PR AMPICILLIN SULBACTAM 1.5 GM"]
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["ZZZUNITED","68382-0003-01 - PR AZATHIOPRINE ORAL 50MG"]
["ZZZUNITED","68462-0470-40 - INJ, BUMETANIDE, 0.5 MG"]
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["ZZZUNITED","68462-0756-01 - PR KETOROLAC TROMETHAMINE INJ"]
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["ZZZUNITED","68727-0712-01 - PR CHEMOTHERAPY DRUG"]
["ZZZUNITED","68817-0134-50 - PR INJ PACLITAXEL (AMERICAN REGENT)"]
["ZZZUNITED","68982-0261-01 - HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION"]
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["ZZZUNITED","69097-0319-32 - PR BUDESONIDE NON-COMP UNIT"]
["ZZZUNITED","69097-0319-87 - PR BUDESONIDE NON-COMP UNIT"]
["ZZZUNITED","69097-0516-07 - PR CYCLOPHOSPHAMIDE ORAL 25 MG"]
["ZZZUNITED","69097-0517-07 - PR CYCLOPHOSPHAMIDE ORAL 25 MG"]
["ZZZUNITED","69097-0709-30 - PR VITAMIN K PHYTONADIONE INJ"]
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["ZZZUNITED","69097-0870-67 - LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE"]
["ZZZUNITED","69374-0920-05 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["ZZZUNITED","69374-0946-04 - PR INJ, LABETALOL HCL, 5MG"]
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["ZZZUNITED","69488-0010-61 - PR LUTETIUM LU 177 VIPIVOTIDE TETRAXETAN, THERAPEUTIC, 1 MILLICURIE"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4879:BE4879,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4880:BE4880,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4881:BE4881,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4882:BE4882,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4883:BE4883,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4884:BE4884,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4885:BE4885,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4886:BE4886,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4887:BE4887,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4888:BE4888,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4889:BE4889,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4890:BE4890,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4891:BE4891,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4892:BE4892,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4893:BE4893,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4894:BE4894,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4895:BE4895,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4896:BE4896,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4897:BE4897,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4898:BE4898,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4899:BE4899,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('NDCPayer&Code&Desc'!D4900:BE4900,,$K$4)","v":0}]

{"sheet":"Average Table - NDC","index":7,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":true,"merged":[],"read":"part_too_large"}

{"sheet":"PayerBillCodeCount (NDC)","index":8,"n_rows":144007,"n_cols":7,"rows_kept":2250,"cut":true,"hidden":true,"merged":[[0,0,0,1],[0,5,0,6]],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
["Payer + NDC combination",null,null,null,null,"NDC Count by Payer"]
["Payer","NDC & Description",null,null,null,"Payer","Count of NDC & Description"]
["AARP UHC MEDICARE COMPLETE","00002-7669-01 - PR CHEMOTHERAPY DRUG",null,null,null,"ZZZAETNA",4898]
["AARP UHC MEDICARE COMPLETE","00002-7678-01 - PR CHEMOTHERAPY DRUG",null,null,null,"UNICARE",4898]
["AARP UHC MEDICARE COMPLETE","00003-0293-05 - PR TRIAMCINOLONE ACETONIDE INJ",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME",4898]
["AARP UHC MEDICARE COMPLETE","00003-0293-20 - PR TRIAMCINOLONE ACETONIDE INJ",null,null,null,"AETNA",4898]
["AARP UHC MEDICARE COMPLETE","00003-0315-05 - PR TRIAMCINOLONE ACETONIDE INJ",null,null,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE",4898]
["AARP UHC MEDICARE COMPLETE","00003-0371-13 - PR BELATACEPT INJECTION",null,null,null,"CIGNA",4898]
["AARP UHC MEDICARE COMPLETE","00003-0494-20 - PR TRIAMCINOLONE ACETONIDE INJ",null,null,null,"ZZZCIGNA",4898]
["AARP UHC MEDICARE COMPLETE","00003-2187-13 - PR ABATACEPT INJECTION",null,null,null,"FALLON",4898]
["AARP UHC MEDICARE COMPLETE","00003-2188-51 - PR ABATACEPT INJECTION",null,null,null,"TUFTS CONNCARE/QHP",4898]
["AARP UHC MEDICARE COMPLETE","00003-2291-11 - PR INJECTION, ELOTUZUMAB, 1MG",null,null,null,"HSN",4898]
["AARP UHC MEDICARE COMPLETE","00003-2327-11 - PR IPILIMUMAB INJECTION",null,null,null,"UPHAMS CORNER ESP",4898]
["AARP UHC MEDICARE COMPLETE","00003-2328-22 - PR IPILIMUMAB INJECTION",null,null,null,"HSN BAD DEBT",4898]
["AARP UHC MEDICARE COMPLETE","00003-2560-16 - AZTREONAM 1 GRAM SOLUTION FOR INJECTION",null,null,null,"WORKERS COMP",4898]
["AARP UHC MEDICARE COMPLETE","00003-2570-16 - AZTREONAM 2 GRAM SOLUTION FOR INJECTION",null,null,null,"HSN CONFIDENTIAL",4898]
["AARP UHC MEDICARE COMPLETE","00003-3734-13 - PR INJECTION, NIVOLUMAB",null,null,null,"ZZZBU EMPLOYEE WORK COMP",4898]
["AARP UHC MEDICARE COMPLETE","00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG",null,null,null,"HSN DENTAL",4898]
["AARP UHC MEDICARE COMPLETE","00004-0038-22 - PR ORAL PRESCRIP DRUG NON CHEMO",null,null,null,"ZZZCITY OF BOSTON WORK COMP",4898]
["AARP UHC MEDICARE COMPLETE","00006-4305-02 - PR INJECTION, RENFLEXIS",null,null,null,"HSN PARTIAL",4898]
["AARP UHC MEDICARE COMPLETE","00009-0011-03 - PR HYDROCORTISONE SODIUM SUCC I",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL",4898]
["AARP UHC MEDICARE COMPLETE","00009-0022-01 - PR METHYLPREDNISOLONE ORAL",null,null,null,"TUFTS",4888]
["AARP UHC MEDICARE COMPLETE","00009-0417-02 - PR INJ TESTOSTERONE CYPIONATE",null,null,null,"UNITED",1595]
["AARP UHC MEDICARE COMPLETE","00009-0746-30 - PR MEDROXYPROGESTERONE ACETATE",null,null,null,"ZZZUNITED",1595]
["AARP UHC MEDICARE COMPLETE","00009-0825-01 - PR HYDROCORTISONE SODIUM SUCC I",null,null,null,"BCBS OUT OF STATE",1594]
["AARP UHC MEDICARE COMPLETE","00009-5140-01 - PR LINEZOLID INJECTION",null,null,null,"BCBS",1594]
["AARP UHC MEDICARE COMPLETE","00009-7376-11 - PR MEDROXYPROGESTERONE ACETATE",null,null,null,"ZZZHEALTH PLANS INC",1522]
["AARP UHC MEDICARE COMPLETE","00009-7529-03 - PR IRINOTECAN INJECTION",null,null,null,"HEALTH PLANS INC",1522]
["AARP UHC MEDICARE COMPLETE","00009-7529-04 - PR IRINOTECAN INJECTION",null,null,null,"HARVARD PILGRIM HEALTH CARE",1522]
["AARP UHC MEDICARE COMPLETE","00019-1333-11 - LOCM 300-399MG/ML IODINE,1ML",null,null,null,"OXFORD HEALTH",1355]
["AARP UHC MEDICARE COMPLETE","00023-6082-01 - PR INJ IRON DEXTRAN",null,null,null,"UNITED MEDICARE MANAGED",1353]
["AARP UHC MEDICARE COMPLETE","00023-6082-10 - PR INJ IRON DEXTRAN",null,null,null,"NEIGHBORHOOD PACE",1353]
["AARP UHC MEDICARE COMPLETE","00024-5823-15 - PR CABAZITAXEL INJECTION",null,null,null,"WELLSENSE MEDICARE MANAGED",1353]
["AARP UHC MEDICARE COMPLETE","00024-5824-11 - PR CABAZITAXEL INJECTION",null,null,null,"HPHC MEDICARE MANAGED",1353]
["AARP UHC MEDICARE COMPLETE","00024-5915-00 - PR UNCLASSIFIED BIOLOGICS",null,null,null,"UNITED COMMUNITY PLAN",1353]
["AARP UHC MEDICARE COMPLETE","00049-0013-81 - PR AMPICILLIN SULBACTAM 1.5 GM",null,null,null,"BCBS MEDICARE MANAGED",1353]
["AARP UHC MEDICARE COMPLETE","00049-0014-83 - PR AMPICILLIN SULBACTAM 1.5 GM",null,null,null,"FALLON SCO",1353]
["AARP UHC MEDICARE COMPLETE","00049-0520-83 - PR PENICILLIN G POTASSIUM INJ",null,null,null,"TUFTS MEDICARE",1353]
["AARP UHC MEDICARE COMPLETE","00049-0520-84 - PR PENICILLIN G POTASSIUM INJ",null,null,null,"HUMANA MEDICARE",1353]
["AARP UHC MEDICARE COMPLETE","00049-0530-28 - PR PENICILLIN G POTASSIUM INJ",null,null,null,"TUFTS MEDICARE MANAGED",1353]
["AARP UHC MEDICARE COMPLETE","00052-0602-02 - PR BCG LIVE INTRAVESICAL 1MG",null,null,null,"AARP UHC MEDICARE COMPLETE",1353]
["AARP UHC MEDICARE COMPLETE","00054-0018-20 - PR PREDNISONE IR OR DR ORAL 1MG",null,null,null,"AETNA MEDICARE MANAGED",1353]
["AARP UHC MEDICARE COMPLETE","00054-0018-25 - PR PREDNISONE IR OR DR ORAL 1MG",null,null,null,"FALLON MEDICARE MANAGED",1353]
["AARP UHC MEDICARE COMPLETE","00054-0018-29 - PR PREDNISONE IR OR DR ORAL 1MG",null,null,null,"ZZZRAILROAD MEDICARE",1351]
["AARP UHC MEDICARE COMPLETE","00054-0019-20 - PR PREDNISONE IR OR DR ORAL 1MG",null,null,null,"UBH HPHC",1351]
["AARP UHC MEDICARE COMPLETE","00054-0019-25 - PR PREDNISONE IR OR DR ORAL 1MG",null,null,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND",1351]
["AARP UHC MEDICARE COMPLETE","00054-0064-47 - PR ONDANSETRON 1 MG, ORAL",null,null,null,"MEDICARE",1351]
["AARP UHC MEDICARE COMPLETE","00054-0383-25 - PR CYCLOPHOSPHAMIDE ORAL 25 MG",null,null,null,"CCA MEDICARE PREFERRED",1347]
["AARP UHC MEDICARE COMPLETE","00054-3177-63 - PR ORAL DEXAMETHASONE",null,null,null,"SENIOR WHOLE HEALTH",1347]
["AARP UHC MEDICARE COMPLETE","00054-4180-25 - PR ORAL DEXAMETHASONE",null,null,null,"ZZZCCA ONECARE",1347]
["AARP UHC MEDICARE COMPLETE","00054-4181-25 - PR ORAL DEXAMETHASONE",null,null,null,"CORRECTIONS",1347]
["AARP UHC MEDICARE COMPLETE","00054-4184-25 - PR ORAL DEXAMETHASONE",null,null,null,"CCA",1347]
["AARP UHC MEDICARE COMPLETE","00054-8174-25 - PR ORAL DEXAMETHASONE",null,null,null,"WELLCARE",1346]
["AARP UHC MEDICARE COMPLETE","00054-8175-25 - PR ORAL DEXAMETHASONE",null,null,null,"TRICARE EAST",1341]
["AARP UHC MEDICARE COMPLETE","00054-8181-25 - PR ORAL DEXAMETHASONE",null,null,null,"TRICARE FOR LIFE",1341]
["AARP UHC MEDICARE COMPLETE","00054-8724-25 - PR PREDNISONE IR OR DR ORAL 1MG",null,null,null,"Grand Total",144005]
["AARP UHC MEDICARE COMPLETE","00054-8739-25 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AARP UHC MEDICARE COMPLETE","00065-0543-01 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AARP UHC MEDICARE COMPLETE","00069-0059-01 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","00069-0305-01 - PR INJ., TRAZIMERA, 10 MG"]
["AARP UHC MEDICARE COMPLETE","00069-0306-01 - PR INJ., TRAZIMERA, 10 MG"]
["AARP UHC MEDICARE COMPLETE","00069-0308-01 - PR INJ., TRAZIMERA, 10 MG"]
["AARP UHC MEDICARE COMPLETE","00069-0315-01 - PR INJ., ZIRABEV, 10 MG"]
["AARP UHC MEDICARE COMPLETE","00069-0342-01 - PR INJ., ZIRABEV, 10 MG"]
["AARP UHC MEDICARE COMPLETE","00069-0809-01 - PR INJECTION, INFLECTRA"]
["AARP UHC MEDICARE COMPLETE","00069-3031-20 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["AARP UHC MEDICARE COMPLETE","00069-3032-20 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["AARP UHC MEDICARE COMPLETE","00069-3034-20 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["AARP UHC MEDICARE COMPLETE","00069-3140-19 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","00069-3150-83 - PR AZITHROMYCIN"]
["AARP UHC MEDICARE COMPLETE","00069-3150-84 - PR AZITHROMYCIN"]
["AARP UHC MEDICARE COMPLETE","00069-4061-89 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","00074-0124-02 - PR ADALIMUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","00074-0554-02 - PR ADALIMUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","00074-1070-01 - PR INJ RISANKIZUMAB-RZAA 1 MG"]
["AARP UHC MEDICARE COMPLETE","00074-3346-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","00074-3473-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","00074-3641-03 - PR LEUPROLIDE ACETATE /3.75 MG"]
["AARP UHC MEDICARE COMPLETE","00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","00074-3663-03 - PR LEUPROLIDE ACETATE /3.75 MG"]
["AARP UHC MEDICARE COMPLETE","00074-3683-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","00074-5015-01 - PR INJ RISANKIZUMAB-RZAA 1 MG"]
["AARP UHC MEDICARE COMPLETE","00074-9694-03 - PR LEUPROLIDE ACETATE /3.75 MG"]
["AARP UHC MEDICARE COMPLETE","00075-0621-60 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00075-0622-80 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00075-0623-00 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00075-0624-30 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00075-0626-03 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00078-0385-66 - PR MYCOPHENOLIC ACID"]
["AARP UHC MEDICARE COMPLETE","00078-0386-66 - PR MYCOPHENOLIC ACID"]
["AARP UHC MEDICARE COMPLETE","00078-0639-68 - PR UNCLASSIFIED BIOLOGICS"]
["AARP UHC MEDICARE COMPLETE","00078-0734-61 - PR CANAKINUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","00078-0790-61 - PR OCTREOTIDE INJECTION, DEPOT"]
["AARP UHC MEDICARE COMPLETE","00078-0797-61 - PR OCTREOTIDE INJECTION, DEPOT"]
["AARP UHC MEDICARE COMPLETE","00078-0804-61 - PR OCTREOTIDE INJECTION, DEPOT"]
["AARP UHC MEDICARE COMPLETE","00078-0818-81 - PR OCTREOTIDE INJECTION, DEPOT"]
["AARP UHC MEDICARE COMPLETE","00078-0825-81 - PR OCTREOTIDE INJECTION, DEPOT"]
["AARP UHC MEDICARE COMPLETE","00078-0883-61 - PR INJ CRIZANLIZUMAB-TMCA 5MG"]
["AARP UHC MEDICARE COMPLETE","00078-1000-60 - PR INJECTION, INCLISIRAN, 1 MG"]
["AARP UHC MEDICARE COMPLETE","00093-2026-31 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","00093-2027-23 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","00093-5061-01 - PR HYDROXYZINE PAMOATE 25MG"]
["AARP UHC MEDICARE COMPLETE","00115-1694-30 - PR ADRENALIN EPINEPHRINE INJECT"]
["AARP UHC MEDICARE COMPLETE","00121-0759-08 - PR PREDNISOLONE ORAL PER 5 MG"]
["AARP UHC MEDICARE COMPLETE","00121-0978-00 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","00121-0978-10 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","00143-9022-02 - PR INJECTION, FULVESTRANT"]
["AARP UHC MEDICARE COMPLETE","00143-9086-01 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["AARP UHC MEDICARE COMPLETE","00143-9087-01 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["AARP UHC MEDICARE COMPLETE","00143-9141-01 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00143-9141-10 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"]
["AARP UHC MEDICARE COMPLETE","00143-9331-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00143-9331-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00143-9333-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00143-9335-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00143-9335-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00143-9398-01 - PR ERTAPENEM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9504-01 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9505-01 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9510-01 - PR ETOPOSIDE 10 MG INJ"]
["AARP UHC MEDICARE COMPLETE","00143-9511-01 - PR ETOPOSIDE 10 MG INJ"]
["AARP UHC MEDICARE COMPLETE","00143-9552-01 - PR LEUCOVORIN CALCIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9553-01 - PR LEUCOVORIN CALCIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9554-01 - PR LEUCOVORIN CALCIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9555-01 - PR LEUCOVORIN CALCIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9606-01 - PR AZACITIDINE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9622-01 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["AARP UHC MEDICARE COMPLETE","00143-9680-01 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["AARP UHC MEDICARE COMPLETE","00143-9681-01 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["AARP UHC MEDICARE COMPLETE","00143-9701-01 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9702-01 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9720-01 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9721-01 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9744-10 - PR GRANISETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9750-01 - PR INJ TESTOSTERO ENANTHATE 1MG"]
["AARP UHC MEDICARE COMPLETE","00143-9856-01 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9856-25 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9857-01 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9857-25 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00143-9875-01 - PR AMIODARONE HCL"]
["AARP UHC MEDICARE COMPLETE","00169-7201-01 - PR FACTOR VIIA"]
["AARP UHC MEDICARE COMPLETE","00173-0881-01 - PR INJECTION, MEPOLIZUMAB, 1MG"]
["AARP UHC MEDICARE COMPLETE","00173-0896-01 - PR CHEMOTHERAPY DRUG"]
["AARP UHC MEDICARE COMPLETE","00173-0898-03 - INJ, DOSTARLIMAB-GXLY, 10 MG"]
["AARP UHC MEDICARE COMPLETE","00187-5600-15 - PR VERTEPORFIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00264-4204-52 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","00264-5535-32 - PR INJ, METRONIDAZOLE, 10 MG"]
["AARP UHC MEDICARE COMPLETE","00264-7578-10 - PR MANNITOL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00264-9587-20 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00264-9872-00 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00264-9872-10 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00270-0445-40 - PR HOCM 350-399MG/ML IODINE,1ML"]
["AARP UHC MEDICARE COMPLETE","00270-1315-30 - LOCM 300-399MG/ML IODINE,1ML"]
["AARP UHC MEDICARE COMPLETE","00270-1316-35 - LOCM 300-399MG/ML IODINE,1ML"]
["AARP UHC MEDICARE COMPLETE","00270-1411-11 - LOCM 200-299MG/ML IODINE,1ML"]
["AARP UHC MEDICARE COMPLETE","00310-0720-10 - PR INJECTION, FULVESTRANT"]
["AARP UHC MEDICARE COMPLETE","00310-3040-00 - ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION"]
["AARP UHC MEDICARE COMPLETE","00310-4505-25 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"]
["AARP UHC MEDICARE COMPLETE","00310-4535-30 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"]
["AARP UHC MEDICARE COMPLETE","00338-0054-03 - HC 250 SHELL"]
["AARP UHC MEDICARE COMPLETE","00338-0067-01 - PR DOXORUBICIN INJ 10MG"]
["AARP UHC MEDICARE COMPLETE","00338-0072-25 - PR KETOROLAC TROMETHAMINE INJ"]
["AARP UHC MEDICARE COMPLETE","00338-0077-03 - PR 5% DEXTROSE/NORMAL SALINE"]
["AARP UHC MEDICARE COMPLETE","00338-0077-04 - PR 5% DEXTROSE/NORMAL SALINE"]
["AARP UHC MEDICARE COMPLETE","00338-0089-03 - PR 5% DEXTROSE/NORMAL SALINE"]
["AARP UHC MEDICARE COMPLETE","00338-0089-04 - PR 5% DEXTROSE/NORMAL SALINE"]
["AARP UHC MEDICARE COMPLETE","00338-0117-04 - PR RINGERS LACTATE INFUSION"]
["AARP UHC MEDICARE COMPLETE","00338-0357-03 - PR MANNITOL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00338-0663-03 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0671-03 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0671-04 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0675-04 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0683-04 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0691-04 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0695-04 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0703-41 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0704-34 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0709-48 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0803-04 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-0807-04 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00338-1023-41 - PR PENICILLIN G POTASSIUM INJ"]
["AARP UHC MEDICARE COMPLETE","00338-1055-48 - PR INJ, METRONIDAZOLE, 10 MG"]
["AARP UHC MEDICARE COMPLETE","00338-1075-02 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00338-1077-02 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00338-1305-01 - PR MESNA INJECTION"]
["AARP UHC MEDICARE COMPLETE","00338-3508-41 - PR INJ CEFAZOLIN SODIUM, BAXTER"]
["AARP UHC MEDICARE COMPLETE","00338-5002-41 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00338-5003-41 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00338-6045-37 - PR FLUCONAZOLE"]
["AARP UHC MEDICARE COMPLETE","00338-6046-48 - PR FLUCONAZOLE"]
["AARP UHC MEDICARE COMPLETE","00378-6997-89 - PR STERILE WATER/SALINE, 10 ML"]
["AARP UHC MEDICARE COMPLETE","00378-7732-93 - PR ONDANSETRON 1 MG, ORAL"]
["AARP UHC MEDICARE COMPLETE","00409-0144-11 - PR AZITHROMYCIN"]
["AARP UHC MEDICARE COMPLETE","00409-0181-01 - PR GEMCITABINE HCL"]
["AARP UHC MEDICARE COMPLETE","00409-0182-01 - PR GEMCITABINE HCL"]
["AARP UHC MEDICARE COMPLETE","00409-0183-01 - PR GEMCITABINE HCL"]
["AARP UHC MEDICARE COMPLETE","00409-0367-01 - PR DOCETAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-0368-01 - PR DOCETAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-0528-23 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-0829-01 - AZTREONAM 1 GRAM SOLUTION FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-0829-11 - AZTREONAM 1 GRAM SOLUTION FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-1134-05 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-1159-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1159-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1160-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1162-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1162-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1163-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1163-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1165-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1165-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1165-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1390-21 - PR MEROPENEM"]
["AARP UHC MEDICARE COMPLETE","00409-1390-51 - PR MEROPENEM"]
["AARP UHC MEDICARE COMPLETE","00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1559-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1582-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1582-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1582-29 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1587-50 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","00409-1593-04 - PR KETOROLAC TROMETHAMINE INJ"]
["AARP UHC MEDICARE COMPLETE","00409-1630-10 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-1630-15 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-1893-01 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-1985-30 - PR LORAZEPAM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-2050-01 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","00409-2050-20 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","00409-2222-01 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00409-2267-20 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["AARP UHC MEDICARE COMPLETE","00409-2267-54 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["AARP UHC MEDICARE COMPLETE","00409-2305-05 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2305-16 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2305-17 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2308-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2308-02 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2308-21 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2339-24 - PR INJ, LABETALOL HCL, 5MG"]
["AARP UHC MEDICARE COMPLETE","00409-2339-34 - PR INJ, LABETALOL HCL, 5MG"]
["AARP UHC MEDICARE COMPLETE","00409-2344-01 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00409-2344-02 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00409-2347-31 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00409-2347-32 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00409-2587-05 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2596-03 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2596-05 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-2720-02 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00409-2720-32 - HEPARIN (PORCINE) 1 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","00409-2723-01 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","00409-2723-02 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","00409-2723-31 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","00409-3414-01 - PR METOCLOPRAMIDE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-3414-18 - PR METOCLOPRAMIDE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-3515-11 - PR INJ, VANCOMYCIN HCL (MYLAN)"]
["AARP UHC MEDICARE COMPLETE","00409-3724-11 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00409-3724-32 - PR INJ DOBUTAMINE HCL/250 MG"]
["AARP UHC MEDICARE COMPLETE","00409-3795-01 - PR KETOROLAC TROMETHAMINE INJ"]
["AARP UHC MEDICARE COMPLETE","00409-3795-19 - PR KETOROLAC TROMETHAMINE INJ"]
["AARP UHC MEDICARE COMPLETE","00409-3815-12 - PR IN MORPHINE PRESERVATIV FREE"]
["AARP UHC MEDICARE COMPLETE","00409-4031-01 - PR MANNITOL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-4520-02 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00409-4520-30 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00409-4755-03 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-4755-18 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-4911-34 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-4933-11 - PR ADRENALIN EPINEPHRINE INJECT"]
["AARP UHC MEDICARE COMPLETE","00409-6102-02 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-6102-04 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-6102-20 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-6102-36 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-6629-02 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["AARP UHC MEDICARE COMPLETE","00409-6651-06 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-6651-19 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-6653-05 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-6653-18 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00409-6727-23 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","00409-6729-23 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","00409-6729-24 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","00409-7332-01 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-7332-11 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-7335-03 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-7335-13 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-7337-01 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-7337-11 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-7338-01 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-7338-11 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-7620-03 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00409-7620-49 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00409-9093-32 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9093-35 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9094-12 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9094-17 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9094-22 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9094-25 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9094-28 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9094-31 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9094-41 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9094-61 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00409-9735-01 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","00409-9735-10 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","00469-0607-73 - PR TACROLIMUS ORAL PER 1 MG"]
["AARP UHC MEDICARE COMPLETE","00469-0871-30 - PR ADENOSINE INJ 1MG"]
["AARP UHC MEDICARE COMPLETE","00469-6501-89 - PR REGADENOSON INJECTION"]
["AARP UHC MEDICARE COMPLETE","00487-9003-30 - PR STERILE WATER/SALINE, 10 ML"]
["AARP UHC MEDICARE COMPLETE","00517-0020-10 - PR CAFFEINE CITRATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-0031-01 - PR VITAMIN B12 INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-0031-25 - PR VITAMIN B12 INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-0032-25 - PR VITAMIN B12 INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-0374-01 - PR VISUALIZATION ADJUNCT"]
["AARP UHC MEDICARE COMPLETE","00517-0374-05 - PR VISUALIZATION ADJUNCT"]
["AARP UHC MEDICARE COMPLETE","00517-0650-01 - PR INJ FERRIC CARBOXYMALTOS 1MG"]
["AARP UHC MEDICARE COMPLETE","00517-0720-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["AARP UHC MEDICARE COMPLETE","00517-0901-01 - PR HYDRALAZINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-0901-25 - PR HYDRALAZINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-1001-01 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-1001-25 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-1004-01 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-1004-25 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-2310-01 - PR IRON SUCROSE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-2310-05 - PR IRON SUCROSE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-2325-10 - PR IRON SUCROSE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-2340-01 - PR IRON SUCROSE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-2340-10 - PR IRON SUCROSE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-2340-25 - PR IRON SUCROSE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00517-4300-01 - PR INJ PACLITAXEL (AMERICAN REGENT)"]
["AARP UHC MEDICARE COMPLETE","00517-4602-25 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["AARP UHC MEDICARE COMPLETE","00517-4605-25 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["AARP UHC MEDICARE COMPLETE","00536-0770-05 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","00548-5400-00 - PR MEDROXYPROGESTERONE ACETATE"]
["AARP UHC MEDICARE COMPLETE","00548-5701-00 - PR MEDROXYPROGESTERONE ACETATE"]
["AARP UHC MEDICARE COMPLETE","00574-0820-01 - PR INJ TESTOSTERONE CYPIONATE"]
["AARP UHC MEDICARE COMPLETE","00574-0827-10 - PR INJ TESTOSTERONE CYPIONATE"]
["AARP UHC MEDICARE COMPLETE","00591-3221-26 - PR INJ TESTOSTERO ENANTHATE 1MG"]
["AARP UHC MEDICARE COMPLETE","00603-5335-21 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AARP UHC MEDICARE COMPLETE","00603-5339-28 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AARP UHC MEDICARE COMPLETE","00641-0367-25 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","00641-0376-21 - PR DIPHENHYDRAMINE HCL INJECTIO"]
["AARP UHC MEDICARE COMPLETE","00641-0376-25 - PR DIPHENHYDRAMINE HCL INJECTIO"]
["AARP UHC MEDICARE COMPLETE","00641-0400-37 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","00641-0410-12 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","00641-0928-21 - PR PROMETHAZINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-0928-25 - PR PROMETHAZINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-1410-35 - PR DIGOXIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-1495-35 - PR PROMETHAZINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6001-01 - PR LORAZEPAM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6001-25 - PR LORAZEPAM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6003-25 - PR LORAZEPAM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6007-10 - INJ, BUMETANIDE, 0.5 MG"]
["AARP UHC MEDICARE COMPLETE","00641-6008-01 - INJ, BUMETANIDE, 0.5 MG"]
["AARP UHC MEDICARE COMPLETE","00641-6008-10 - INJ, BUMETANIDE, 0.5 MG"]
["AARP UHC MEDICARE COMPLETE","00641-6019-01 - PR IN MORPHINE PRESERVATIV FREE"]
["AARP UHC MEDICARE COMPLETE","00641-6019-10 - PR IN MORPHINE PRESERVATIV FREE"]
["AARP UHC MEDICARE COMPLETE","00641-6027-01 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00641-6027-25 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00641-6028-01 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00641-6028-25 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00641-6030-01 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","00641-6040-01 - PR IN MORPHINE PRESERVATIV FREE"]
["AARP UHC MEDICARE COMPLETE","00641-6044-01 - PR LORAZEPAM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6044-25 - PR LORAZEPAM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6046-10 - PR LORAZEPAM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6057-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00641-6057-25 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00641-6059-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00641-6059-10 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00641-6060-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00641-6061-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00641-6061-25 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00641-6078-01 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6078-25 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6125-01 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6125-25 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6126-01 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6126-25 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6127-25 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6149-01 - PR NEOSTIGMINE METHYLSLFTE INJ"]
["AARP UHC MEDICARE COMPLETE","00641-6149-10 - PR NEOSTIGMINE METHYLSLFTE INJ"]
["AARP UHC MEDICARE COMPLETE","00641-6164-10 - PR CAFFEINE CITRATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6167-01 - PR AMIKACIN SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6167-10 - PR AMIKACIN SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6228-01 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","00641-6228-25 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","00641-6231-01 - PR HYDRALAZINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00641-6253-01 - PR REGADENOSON INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-0241-01 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AARP UHC MEDICARE COMPLETE","00703-3213-01 - PR PACLITAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-3217-01 - PR PACLITAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-3218-01 - PR PACLITAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-3985-01 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","00703-3986-01 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","00703-4239-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-4244-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-4246-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-4248-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-4502-01 - PR METOCLOPRAMIDE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-5747-11 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","00703-5748-11 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","00781-2323-06 - PR ORAL APREPITANT"]
["AARP UHC MEDICARE COMPLETE","00781-3059-72 - PR DIGOXIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","00781-3154-01 - PR FERUMOXYTOL, ESRD USE"]
["AARP UHC MEDICARE COMPLETE","00781-3158-94 - PR BIVALIRUDIN"]
["AARP UHC MEDICARE COMPLETE","00781-3206-95 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00781-3208-95 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","00781-3238-01 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00781-3238-63 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00781-3268-69 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00781-3315-70 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","00781-3317-80 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","00781-3407-78 - PR AMPICILLIN 500 MG INJ"]
["AARP UHC MEDICARE COMPLETE","00781-3407-95 - PR AMPICILLIN 500 MG INJ"]
["AARP UHC MEDICARE COMPLETE","00781-3466-70 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["AARP UHC MEDICARE COMPLETE","00832-6019-01 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","00832-6019-89 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","00904-2056-61 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","00904-5307-60 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","00904-5790-61 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["AARP UHC MEDICARE COMPLETE","00904-6551-61 - PR ONDANSETRON 1 MG, ORAL"]
["AARP UHC MEDICARE COMPLETE","00904-6552-61 - PR ONDANSETRON 1 MG, ORAL"]
["AARP UHC MEDICARE COMPLETE","00904-6617-61 - PR HYDROXYZINE PAMOATE 25MG"]
["AARP UHC MEDICARE COMPLETE","00904-6923-61 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AARP UHC MEDICARE COMPLETE","00904-6985-16 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","00904-6985-20 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","00904-7127-61 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AARP UHC MEDICARE COMPLETE","00904-7131-61 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","00904-7237-61 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","00944-2510-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2511-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2512-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2513-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2514-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2700-04 - PR GAMMAGARD LIQUID INJECTION"]
["AARP UHC MEDICARE COMPLETE","00944-2700-05 - PR GAMMAGARD LIQUID INJECTION"]
["AARP UHC MEDICARE COMPLETE","00944-2700-06 - PR GAMMAGARD LIQUID INJECTION"]
["AARP UHC MEDICARE COMPLETE","00944-2700-07 - PR GAMMAGARD LIQUID INJECTION"]
["AARP UHC MEDICARE COMPLETE","00944-2700-10 - PR GAMMAGARD LIQUID INJECTION"]
["AARP UHC MEDICARE COMPLETE","00944-2700-11 - PR GAMMAGARD LIQUID INJECTION"]
["AARP UHC MEDICARE COMPLETE","00944-2700-12 - PR GAMMAGARD LIQUID INJECTION"]
["AARP UHC MEDICARE COMPLETE","00944-2700-13 - PR GAMMAGARD LIQUID INJECTION"]
["AARP UHC MEDICARE COMPLETE","00944-2715-25 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2716-05 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2717-10 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2718-20 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2719-30 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AARP UHC MEDICARE COMPLETE","00944-2803-03 - PR ALPHA 1 PROTEINASE INHIBITOR"]
["AARP UHC MEDICARE COMPLETE","00944-2814-01 - PR ALPHA 1 PROTEINASE INHIBITOR"]
["AARP UHC MEDICARE COMPLETE","00944-2815-01 - PR ALPHA 1 PROTEINASE INHIBITOR"]
["AARP UHC MEDICARE COMPLETE","00944-3045-10 - PR FACTOR VIII RECOMBINANT NOS"]
["AARP UHC MEDICARE COMPLETE","00944-3053-02 - PR FACTOR VIII RECOMBINANT NOS"]
["AARP UHC MEDICARE COMPLETE","00955-1004-10 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00955-1006-10 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00955-1010-10 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00955-1016-01 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","00990-7074-26 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00990-7077-14 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","00990-7715-13 - PR MANNITOL INJECTION"]
["AARP UHC MEDICARE COMPLETE","08290-3064-14 - PR INJ HEPARIN SODIUM PER 10 U"]
["AARP UHC MEDICARE COMPLETE","08290-3064-24 - PR INJ HEPARIN SODIUM PER 10 U"]
["AARP UHC MEDICARE COMPLETE","09994-0891-83 - PR AZATHIOPRINE ORAL 50MG"]
["AARP UHC MEDICARE COMPLETE","09999-1282-77 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","09999-1286-28 - PR IN MORPHINE PRESERVATIV FREE"]
["AARP UHC MEDICARE COMPLETE","09999-1289-36 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","09999-4006-05 - PR VANCOMYCIN HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","09999-4050-46 - PR INJ HEPARIN SODIUM PER 10 U"]
["AARP UHC MEDICARE COMPLETE","09999-9308-51 - PR MORPHINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","09999-9995-25 - PR BEVACIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","10019-0075-87 - ESMOLOL 2 000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV"]
["AARP UHC MEDICARE COMPLETE","10019-0120-01 - PR INJ, ESMOLOL HCL, 10MG"]
["AARP UHC MEDICARE COMPLETE","10019-0953-62 - PR MESNA INJECTION"]
["AARP UHC MEDICARE COMPLETE","10702-0011-01 - PR HYDROXYZINE PAMOATE 25MG"]
["AARP UHC MEDICARE COMPLETE","12496-0100-01 - PR BUPRENORPH XR 100 MG OR LESS"]
["AARP UHC MEDICARE COMPLETE","12496-0300-01 - PR BUPRENORPHINE XR OVER 100 MG"]
["AARP UHC MEDICARE COMPLETE","14789-0107-08 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","14789-0109-10 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","14789-0109-16 - PR INJ POTASSIUM CHLORIDE"]
["AARP UHC MEDICARE COMPLETE","14789-0600-07 - PR ARSENIC TRIOXIDE"]
["AARP UHC MEDICARE COMPLETE","15054-1060-04 - PR LANREOTIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","15054-1090-04 - PR LANREOTIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","15054-1120-04 - LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE"]
["AARP UHC MEDICARE COMPLETE","16729-0041-01 - PR TACROLIMUS ORAL PER 1 MG"]
["AARP UHC MEDICARE COMPLETE","16729-0042-01 - PR TACROLIMUS ORAL PER 1 MG"]
["AARP UHC MEDICARE COMPLETE","16729-0043-01 - PR TACROLIMUS ORAL PER 1 MG"]
["AARP UHC MEDICARE COMPLETE","16729-0114-11 - PR ETOPOSIDE 10 MG INJ"]
["AARP UHC MEDICARE COMPLETE","16729-0189-29 - PR MYCOPHENOLIC ACID"]
["AARP UHC MEDICARE COMPLETE","16729-0242-31 - PR ZOLDERONIC ACID 1MG"]
["AARP UHC MEDICARE COMPLETE","16729-0261-29 - PR MYCOPHENOLIC ACID"]
["AARP UHC MEDICARE COMPLETE","16729-0267-63 - PR DOCETAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0267-65 - PR DOCETAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0275-67 - PR BIVALIRUDIN"]
["AARP UHC MEDICARE COMPLETE","16729-0276-11 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0276-38 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0288-11 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0295-34 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0306-10 - PR AZACITIDINE INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0332-03 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","16729-0472-30 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["AARP UHC MEDICARE COMPLETE","16729-0500-08 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0500-30 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0526-08 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","16729-0526-63 - PR ATROPINE SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","18657-0117-04 - PR HYALURONIDASE RECOMBINANT"]
["AARP UHC MEDICARE COMPLETE","19515-0814-41 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["AARP UHC MEDICARE COMPLETE","19515-0814-52 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["AARP UHC MEDICARE COMPLETE","23155-0170-31 - PR ZOLDERONIC ACID 1MG"]
["AARP UHC MEDICARE COMPLETE","23155-0227-01 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["AARP UHC MEDICARE COMPLETE","23155-0290-31 - PR AMIKACIN SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","23155-0290-41 - PR AMIKACIN SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","23155-0473-31 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","23155-0473-32 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","23155-0473-33 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","23155-0473-42 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","23155-0473-44 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","23155-0547-31 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0106-10 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0107-20 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0121-20 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0122-50 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0122-67 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0132-81 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0132-82 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0132-83 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0135-10 - PR AMPICILLIN 500 MG INJ"]
["AARP UHC MEDICARE COMPLETE","25021-0136-10 - PR AMPICILLIN 500 MG INJ"]
["AARP UHC MEDICARE COMPLETE","25021-0137-20 - PR AMPICILLIN 500 MG INJ"]
["AARP UHC MEDICARE COMPLETE","25021-0142-20 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["AARP UHC MEDICARE COMPLETE","25021-0143-30 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["AARP UHC MEDICARE COMPLETE","25021-0173-02 - PR AMIKACIN SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0173-04 - PR AMIKACIN SULFATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0184-87 - PR FLUCONAZOLE"]
["AARP UHC MEDICARE COMPLETE","25021-0201-10 - PR MESNA INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0207-51 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["AARP UHC MEDICARE COMPLETE","25021-0215-99 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0227-06 - PR ARSENIC TRIOXIDE"]
["AARP UHC MEDICARE COMPLETE","25021-0230-02 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0230-05 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0233-10 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","25021-0233-20 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","25021-0235-50 - PR GEMCITABINE HCL"]
["AARP UHC MEDICARE COMPLETE","25021-0245-04 - PR DOCETAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0253-50 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0253-51 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0309-82 - ESMOLOL 2 000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV"]
["AARP UHC MEDICARE COMPLETE","25021-0311-02 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0311-04 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0311-10 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0400-10 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","25021-0401-02 - HEPARIN  PORCINE (PF) 1 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","25021-0402-10 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","25021-0410-77 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","25021-0451-01 - PR OCTREOTIDE INJ, NON-DEPOT"]
["AARP UHC MEDICARE COMPLETE","25021-0461-10 - PR INJ DESMOPRESSIN ACETATE"]
["AARP UHC MEDICARE COMPLETE","25021-0500-02 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","25021-0502-01 - PR VITAMIN B12 INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0601-03 - PR CAFFEINE CITRATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0611-10 - PR NEOSTIGMINE METHYLSLFTE INJ"]
["AARP UHC MEDICARE COMPLETE","25021-0612-82 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","25021-0701-01 - PR KETOROLAC TROMETHAMINE INJ"]
["AARP UHC MEDICARE COMPLETE","25021-0777-02 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0801-66 - PR ZOLDERONIC ACID 1MG"]
["AARP UHC MEDICARE COMPLETE","25021-0806-01 - PR HALOPERIDOL INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0814-30 - PR LEUCOVORIN CALCIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0815-30 - PR LEUCOVORIN CALCIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0816-30 - PR LEUCOVORIN CALCIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","25021-0826-82 - PR ZOLDERONIC ACID 1MG"]
["AARP UHC MEDICARE COMPLETE","25021-0828-50 - PR LEUCOVORIN CALCIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","25682-0025-01 - PR RAVULIZUMAB-CWVZ"]
["AARP UHC MEDICARE COMPLETE","25682-0028-01 - PR RAVULIZUMAB-CWVZ"]
["AARP UHC MEDICARE COMPLETE","31722-0681-47 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["AARP UHC MEDICARE COMPLETE","31722-0832-60 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["AARP UHC MEDICARE COMPLETE","36000-0012-25 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","36000-0046-24 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","36000-0047-24 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","36000-0282-25 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","36000-0283-25 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","36000-0284-25 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","36000-0322-02 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["AARP UHC MEDICARE COMPLETE","36000-0324-01 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["AARP UHC MEDICARE COMPLETE","36000-0324-02 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["AARP UHC MEDICARE COMPLETE","42023-0116-02 - PR OXYTOCIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","42023-0116-25 - PR OXYTOCIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","42023-0159-25 - PR ADRENALIN EPINEPHRINE INJECT"]
["AARP UHC MEDICARE COMPLETE","42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"]
["AARP UHC MEDICARE COMPLETE","42023-0189-01 - PR NEOSTIGMINE METHYLSLFTE INJ"]
["AARP UHC MEDICARE COMPLETE","42023-0214-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["AARP UHC MEDICARE COMPLETE","42023-0221-10 - PR ERTAPENEM INJECTION"]
["AARP UHC MEDICARE COMPLETE","42023-0237-10 - PR INJ, VASOPRESSIN, 1 UNIT"]
["AARP UHC MEDICARE COMPLETE","42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"]
["AARP UHC MEDICARE COMPLETE","43066-0023-01 - PR ROPIVACAINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","43066-0023-10 - PR ROPIVACAINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","43598-0050-11 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","43598-0050-25 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","43598-0053-11 - PR INJ DESMOPRESSIN ACETATE"]
["AARP UHC MEDICARE COMPLETE","43598-0258-11 - PR DOCETAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","43598-0262-02 - PR INJECTION, FULVESTRANT"]
["AARP UHC MEDICARE COMPLETE","43598-0262-11 - PR INJECTION, FULVESTRANT"]
["AARP UHC MEDICARE COMPLETE","43598-0305-62 - PR AZACITIDINE INJECTION"]
["AARP UHC MEDICARE COMPLETE","43598-0529-11 - PR NEOSTIGMINE METHYLSLFTE INJ"]
["AARP UHC MEDICARE COMPLETE","43598-0541-25 - PR DOXORUBICIN INJ 10MG"]
["AARP UHC MEDICARE COMPLETE","43598-0616-11 - PR REGADENOSON INJECTION"]
["AARP UHC MEDICARE COMPLETE","43598-0901-11 - PR ERTAPENEM INJECTION"]
["AARP UHC MEDICARE COMPLETE","43598-0901-58 - PR ERTAPENEM INJECTION"]
["AARP UHC MEDICARE COMPLETE","44087-3535-01 - PR INJECTION, AVELUMAB, 10 MG"]
["AARP UHC MEDICARE COMPLETE","44206-0451-01 - PR HIZENTRA INJECTION"]
["AARP UHC MEDICARE COMPLETE","44206-0452-02 - PR HIZENTRA INJECTION"]
["AARP UHC MEDICARE COMPLETE","44206-0452-91 - PR HIZENTRA INJECTION"]
["AARP UHC MEDICARE COMPLETE","44206-0454-04 - PR HIZENTRA INJECTION"]
["AARP UHC MEDICARE COMPLETE","44206-0455-10 - PR HIZENTRA INJECTION"]
["AARP UHC MEDICARE COMPLETE","44206-0455-93 - PR HIZENTRA INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0103-10 - PR AMPICILLIN 500 MG INJ"]
["AARP UHC MEDICARE COMPLETE","44567-0130-10 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0131-10 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0210-10 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["AARP UHC MEDICARE COMPLETE","44567-0211-10 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["AARP UHC MEDICARE COMPLETE","44567-0240-10 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0241-10 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0311-10 - PR PENICILLIN G POTASSIUM INJ"]
["AARP UHC MEDICARE COMPLETE","44567-0400-10 - PR MEROPENEM"]
["AARP UHC MEDICARE COMPLETE","44567-0420-00 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","44567-0421-00 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","44567-0435-24 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0436-24 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0437-24 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0620-01 - PR CALCIUM GLUCON (WG CRITICAL)"]
["AARP UHC MEDICARE COMPLETE","44567-0620-24 - PR CALCIUM GLUCON (WG CRITICAL)"]
["AARP UHC MEDICARE COMPLETE","44567-0700-25 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0701-25 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","44567-0702-25 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","45963-0538-30 - PR ONDANSETRON 1 MG, ORAL"]
["AARP UHC MEDICARE COMPLETE","45963-0614-51 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","45963-0614-55 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","45963-0733-57 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["AARP UHC MEDICARE COMPLETE","45963-0733-60 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["AARP UHC MEDICARE COMPLETE","45963-0765-52 - PR DOCETAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","47335-0049-40 - PR DOXORUBICIN INJ 10MG"]
["AARP UHC MEDICARE COMPLETE","47335-0050-40 - PR DOXORUBICIN INJ 10MG"]
["AARP UHC MEDICARE COMPLETE","47335-0993-01 - PR INJ, METRONIDAZOLE, 10 MG"]
["AARP UHC MEDICARE COMPLETE","47781-0584-93 - PR KETOROLAC TROMETHAMINE INJ"]
["AARP UHC MEDICARE COMPLETE","47781-0588-46 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","47781-0914-01 - PR ORAL DEXAMETHASONE"]
["AARP UHC MEDICARE COMPLETE","48102-0047-01 - PR ORAL DEXAMETHASONE"]
["AARP UHC MEDICARE COMPLETE","48102-0047-20 - PR ORAL DEXAMETHASONE"]
["AARP UHC MEDICARE COMPLETE","49281-0123-65 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["AARP UHC MEDICARE COMPLETE","49281-0123-88 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["AARP UHC MEDICARE COMPLETE","49281-0400-10 - PR TDAP VACCINE >7 YO, IM"]
["AARP UHC MEDICARE COMPLETE","49281-0400-58 - PR TDAP VACCINE >7 YO, IM"]
["AARP UHC MEDICARE COMPLETE","49281-0423-50 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["AARP UHC MEDICARE COMPLETE","49281-0423-88 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["AARP UHC MEDICARE COMPLETE","49401-0088-01 - PR BELIMUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","49401-0088-35 - PR BELIMUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","49401-0101-01 - PR BELIMUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","49401-0102-01 - PR BELIMUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","49702-0240-15 - PR INJECTION, CABOTEGRAVIR AND RILPIVIRINE, 2MG/3MG"]
["AARP UHC MEDICARE COMPLETE","49702-0253-15 - PR INJECTION, CABOTEGRAVIR AND RILPIVIRINE, 2MG/3MG"]
["AARP UHC MEDICARE COMPLETE","50190-0142-63 - PR STERILE WATER/SALINE, 10 ML"]
["AARP UHC MEDICARE COMPLETE","50242-0040-62 - PR OMALIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0041-10 - PR ALTEPLASE RECOMBINANT"]
["AARP UHC MEDICARE COMPLETE","50242-0041-64 - PR ALTEPLASE RECOMBINANT"]
["AARP UHC MEDICARE COMPLETE","50242-0044-06 - PR ALTEPLASE RECOMBINANT"]
["AARP UHC MEDICARE COMPLETE","50242-0044-13 - PR ALTEPLASE RECOMBINANT"]
["AARP UHC MEDICARE COMPLETE","50242-0060-99 - PR BEVACIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0070-01 - PR OBINUTUZUMAB INJ"]
["AARP UHC MEDICARE COMPLETE","50242-0085-25 - PR ALTEPLASE RECOMBINANT"]
["AARP UHC MEDICARE COMPLETE","50242-0085-27 - PR ALTEPLASE RECOMBINANT"]
["AARP UHC MEDICARE COMPLETE","50242-0087-01 - PR INJ, ADO-TRASTUZUMAB EMT 1MG"]
["AARP UHC MEDICARE COMPLETE","50242-0088-01 - PR INJ, ADO-TRASTUZUMAB EMT 1MG"]
["AARP UHC MEDICARE COMPLETE","50242-0096-01 - INJ, FARICIMAB-SVOA, 0.1MG"]
["AARP UHC MEDICARE COMPLETE","50242-0103-01 - INJ, POLATUZUMAB VEDOTIN 1MG"]
["AARP UHC MEDICARE COMPLETE","50242-0105-01 - INJ, POLATUZUMAB VEDOTIN 1MG"]
["AARP UHC MEDICARE COMPLETE","50242-0135-01 - PR TOCILIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0136-01 - PR TOCILIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0137-01 - PR TOCILIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0138-01 - PR TOCILIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0143-01 - PR TOCILIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0145-01 - PR INJECTION, PERTUZUMAB, 1 MG"]
["AARP UHC MEDICARE COMPLETE","50242-0214-01 - PR OMALIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0215-01 - PR OMALIZUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","50242-0245-01 - PERTUZUMAB 1 200 MG-TRASTUZUMAB 600 MG-HYALURON-ZZXF/15 ML SUBCUT SOLN"]
["AARP UHC MEDICARE COMPLETE","50242-0260-01 - PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN"]
["AARP UHC MEDICARE COMPLETE","50242-0917-01 - PR INJ, ATEZOLIZUMAB,10 MG"]
["AARP UHC MEDICARE COMPLETE","50242-0918-01 - PR INJ, ATEZOLIZUMAB,10 MG"]
["AARP UHC MEDICARE COMPLETE","50268-0061-15 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["AARP UHC MEDICARE COMPLETE","50268-0164-11 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","50268-0164-15 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","50268-0621-11 - PR ONDANSETRON 1 MG, ORAL"]
["AARP UHC MEDICARE COMPLETE","50268-0685-11 - PR PROCHLORPERAZINE MALEATE 5MG"]
["AARP UHC MEDICARE COMPLETE","50268-0685-15 - PR PROCHLORPERAZINE MALEATE 5MG"]
["AARP UHC MEDICARE COMPLETE","50268-0787-11 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["AARP UHC MEDICARE COMPLETE","50268-0787-12 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["AARP UHC MEDICARE COMPLETE","50474-0700-62 - CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT"]
["AARP UHC MEDICARE COMPLETE","50580-0534-05 - PR DIPHENHYDRAMINE HCL 50MG"]
["AARP UHC MEDICARE COMPLETE","50742-0447-45 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","51079-0130-20 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","51079-0518-01 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","51079-0518-20 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","51079-0519-01 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","51079-0519-20 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","51144-0020-01 - PR INJ ENFORT VEDO-EJFV 0.25MG"]
["AARP UHC MEDICARE COMPLETE","51144-0030-01 - PR INJ ENFORT VEDO-EJFV 0.25MG"]
["AARP UHC MEDICARE COMPLETE","51144-0050-01 - PR BRENTUXIMAB VEDOTIN INJ"]
["AARP UHC MEDICARE COMPLETE","51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","51672-4091-03 - PR ONDANSETRON 1 MG, ORAL"]
["AARP UHC MEDICARE COMPLETE","51754-0500-01 - PR CAFFEINE CITRATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","51754-5060-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["AARP UHC MEDICARE COMPLETE","51927-1202-00 - PR CAFFEINE CITRATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","51991-0735-20 - PR GRANISETRON HCL 1 MG ORAL"]
["AARP UHC MEDICARE COMPLETE","51991-0735-99 - PR GRANISETRON HCL 1 MG ORAL"]
["AARP UHC MEDICARE COMPLETE","54288-0103-01 - PR ADRENALIN EPINEPHRINE INJECT"]
["AARP UHC MEDICARE COMPLETE","54288-0164-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","54288-0165-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","54288-0166-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","54288-0167-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","54879-0022-01 - PR CYCLOPHOSPHAMIDE ORAL 25 MG"]
["AARP UHC MEDICARE COMPLETE","54879-0037-10 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["AARP UHC MEDICARE COMPLETE","54879-0037-25 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["AARP UHC MEDICARE COMPLETE","55111-0525-01 - PR TACROLIMUS ORAL PER 1 MG"]
["AARP UHC MEDICARE COMPLETE","55111-0526-01 - PR TACROLIMUS ORAL PER 1 MG"]
["AARP UHC MEDICARE COMPLETE","55111-0527-01 - PR TACROLIMUS ORAL PER 1 MG"]
["AARP UHC MEDICARE COMPLETE","55111-0652-07 - PR BIVALIRUDIN"]
["AARP UHC MEDICARE COMPLETE","55111-0685-07 - PR ZOLDERONIC ACID 1MG"]
["AARP UHC MEDICARE COMPLETE","55111-0694-07 - PR PALONOSETRON HCL"]
["AARP UHC MEDICARE COMPLETE","55135-0132-01 - PR SACITUZUMAB GOVITECAN-HZIY"]
["AARP UHC MEDICARE COMPLETE","55150-0113-10 - PR AMPICILLIN 500 MG INJ"]
["AARP UHC MEDICARE COMPLETE","55150-0114-20 - PR AMPICILLIN 500 MG INJ"]
["AARP UHC MEDICARE COMPLETE","55150-0116-20 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["AARP UHC MEDICARE COMPLETE","55150-0117-20 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["AARP UHC MEDICARE COMPLETE","55150-0125-02 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0167-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","55150-0168-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","55150-0169-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","55150-0170-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","55150-0171-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","55150-0172-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","55150-0174-10 - PR AZITHROMYCIN"]
["AARP UHC MEDICARE COMPLETE","55150-0180-03 - PR AMIODARONE HCL"]
["AARP UHC MEDICARE COMPLETE","55150-0193-01 - PR ADENOSINE INJ 1MG"]
["AARP UHC MEDICARE COMPLETE","55150-0193-30 - PR ADENOSINE INJ 1MG"]
["AARP UHC MEDICARE COMPLETE","55150-0194-10 - PR INJ, ESMOLOL HCL, 10MG"]
["AARP UHC MEDICARE COMPLETE","55150-0197-20 - PR ROPIVACAINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0198-30 - PR ROPIVACAINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0207-20 - PR MEROPENEM"]
["AARP UHC MEDICARE COMPLETE","55150-0210-10 - PR BIVALIRUDIN"]
["AARP UHC MEDICARE COMPLETE","55150-0242-51 - PR LINEZOLID INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0245-52 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0273-01 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","55150-0273-25 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","55150-0304-01 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","55150-0304-25 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","55150-0322-25 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0331-01 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","55150-0332-01 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","55150-0335-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0386-01 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0393-01 - PR AZACITIDINE INJECTION"]
["AARP UHC MEDICARE COMPLETE","55150-0421-01 - ESMOLOL 2 000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV"]
["AARP UHC MEDICARE COMPLETE","55150-0421-10 - ESMOLOL 2 000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV"]
["AARP UHC MEDICARE COMPLETE","55390-0500-02 - INJ, BUMETANIDE, 0.5 MG"]
["AARP UHC MEDICARE COMPLETE","55390-0500-05 - INJ, BUMETANIDE, 0.5 MG"]
["AARP UHC MEDICARE COMPLETE","55513-0005-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0006-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0021-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0023-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0023-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0025-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0027-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0027-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0028-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0032-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0057-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0057-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0111-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"]
["AARP UHC MEDICARE COMPLETE","55513-0132-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"]
["AARP UHC MEDICARE COMPLETE","55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"]
["AARP UHC MEDICARE COMPLETE","55513-0221-01 - PR ROMIPLOSTIM INJECTION"]
["AARP UHC MEDICARE COMPLETE","55513-0222-01 - PR ROMIPLOSTIM INJECTION"]
["AARP UHC MEDICARE COMPLETE","55513-0223-01 - PR ROMIPLOSTIM INJECTION"]
["AARP UHC MEDICARE COMPLETE","55513-0224-01 - PR INJ. RIABNI, 10 MG"]
["AARP UHC MEDICARE COMPLETE","55513-0326-01 - PR INJ. RIABNI, 10 MG"]
["AARP UHC MEDICARE COMPLETE","55513-0530-10 - PR INJ, FILGRASTIM G-CSF 1MCG"]
["AARP UHC MEDICARE COMPLETE","55513-0546-10 - PR INJ, FILGRASTIM G-CSF 1MCG"]
["AARP UHC MEDICARE COMPLETE","55513-0710-01 - PR INJECTION DENOSUMAB 60MG/1ML SYRG"]
["AARP UHC MEDICARE COMPLETE","55513-0730-01 - PR INJECTION DENOSUMAB 60MG/1ML SYRG"]
["AARP UHC MEDICARE COMPLETE","55513-0880-02 - HC 636 SHELL"]
["AARP UHC MEDICARE COMPLETE","55513-0924-01 - PR INJ, FILGRASTIM G-CSF 1MCG"]
["AARP UHC MEDICARE COMPLETE","55513-0954-01 - PANITUMUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","55513-0956-01 - PANITUMUMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","55566-2200-00 - PR INJ DESMOPRESSIN ACETATE"]
["AARP UHC MEDICARE COMPLETE","55566-2300-00 - PR INJ DESMOPRESSIN ACETATE"]
["AARP UHC MEDICARE COMPLETE","55566-8303-01 - PR DEGARELIX INJECTION"]
["AARP UHC MEDICARE COMPLETE","55566-8402-00 - PR DEGARELIX INJECTION"]
["AARP UHC MEDICARE COMPLETE","55566-8403-01 - PR DEGARELIX INJECTION"]
["AARP UHC MEDICARE COMPLETE","57237-0075-30 - PR ONDANSETRON 1 MG, ORAL"]
["AARP UHC MEDICARE COMPLETE","57237-0076-30 - PR ONDANSETRON 1 MG, ORAL"]
["AARP UHC MEDICARE COMPLETE","57664-0683-31 - PR LINEZOLID INJECTION"]
["AARP UHC MEDICARE COMPLETE","57894-0030-01 - PR INFLIXIMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","57894-0160-01 - PR INFLIXIMAB INJECTION"]
["AARP UHC MEDICARE COMPLETE","57894-0350-01 - PR INJECTABLE MEDS"]
["AARP UHC MEDICARE COMPLETE","57894-0449-01 - TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION"]
["AARP UHC MEDICARE COMPLETE","57894-0450-01 - TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION"]
["AARP UHC MEDICARE COMPLETE","57894-0501-00 - AMIVANTAMAB-VMJW 50 MG/ML INTRAVENOUS SOLUTION"]
["AARP UHC MEDICARE COMPLETE","57894-0501-01 - AMIVANTAMAB-VMJW 50 MG/ML INTRAVENOUS SOLUTION"]
["AARP UHC MEDICARE COMPLETE","57894-0503-01 - PR UNCLASSIFIED BIOLOGICS"]
["AARP UHC MEDICARE COMPLETE","58160-0842-11 - PR TDAP VACCINE >7 YO, IM"]
["AARP UHC MEDICARE COMPLETE","58160-0842-43 - PR TDAP VACCINE >7 YO, IM"]
["AARP UHC MEDICARE COMPLETE","58160-0842-52 - PR TDAP VACCINE >7 YO, IM"]
["AARP UHC MEDICARE COMPLETE","58468-0090-01 - PR SYNVISC OR SYNVISC-ONE"]
["AARP UHC MEDICARE COMPLETE","59310-0610-31 - PR INJECTION, RESLIZUMAB, 1MG"]
["AARP UHC MEDICARE COMPLETE","59338-0775-01 - PR FERUMOXYTOL, ESRD USE"]
["AARP UHC MEDICARE COMPLETE","59572-0102-01 - PR AZACITIDINE INJECTION"]
["AARP UHC MEDICARE COMPLETE","59572-0711-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"]
["AARP UHC MEDICARE COMPLETE","59572-0775-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"]
["AARP UHC MEDICARE COMPLETE","59676-0302-00 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0302-01 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0303-00 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0303-01 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0304-00 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0304-01 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0310-00 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0310-01 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0310-02 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0320-00 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0320-04 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0340-00 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59676-0340-01 - PR EPOETIN ALFA, NON-ESRD"]
["AARP UHC MEDICARE COMPLETE","59746-0002-04 - PR METHYLPREDNISOLONE ORAL"]
["AARP UHC MEDICARE COMPLETE","59746-0113-06 - PR PROCHLORPERAZINE MALEATE 5MG"]
["AARP UHC MEDICARE COMPLETE","59746-0171-06 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AARP UHC MEDICARE COMPLETE","59762-0049-01 - PR METHYLPREDNISOLONE ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-2198-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-2198-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-3051-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-3060-02 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-3060-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-3080-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-3140-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-4440-03 - PR METHYLPREDNISOLONE ORAL"]
["AARP UHC MEDICARE COMPLETE","59762-4538-02 - PR MEDROXYPROGESTERONE ACETATE"]
["AARP UHC MEDICARE COMPLETE","60219-1076-01 - PR AZATHIOPRINE ORAL 50MG"]
["AARP UHC MEDICARE COMPLETE","60505-0791-00 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","60505-0791-04 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","60505-0798-00 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","60505-0798-04 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","60505-2965-07 - PR MYCOPHENOLIC ACID"]
["AARP UHC MEDICARE COMPLETE","60505-2966-07 - PR MYCOPHENOLIC ACID"]
["AARP UHC MEDICARE COMPLETE","60505-6101-04 - PR BIVALIRUDIN"]
["AARP UHC MEDICARE COMPLETE","60505-6128-00 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","60505-6128-01 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","60505-6130-05 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","60505-6132-06 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","60505-6132-07 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","60505-6147-00 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","60505-6147-04 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","60505-6151-04 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","60505-6180-00 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["AARP UHC MEDICARE COMPLETE","60505-6180-05 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["AARP UHC MEDICARE COMPLETE","60505-6196-00 - PR ERTAPENEM INJECTION"]
["AARP UHC MEDICARE COMPLETE","60505-6277-00 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","60687-0145-01 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AARP UHC MEDICARE COMPLETE","60687-0145-11 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AARP UHC MEDICARE COMPLETE","60687-0419-01 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","60687-0419-11 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","60687-0430-01 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","60687-0430-11 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["AARP UHC MEDICARE COMPLETE","60687-0718-01 - PR ORAL DEXAMETHASONE"]
["AARP UHC MEDICARE COMPLETE","60687-0718-11 - PR ORAL DEXAMETHASONE"]
["AARP UHC MEDICARE COMPLETE","60793-0700-10 - PR PENICILLIN G BENZATHINE INJ"]
["AARP UHC MEDICARE COMPLETE","60793-0701-10 - PR PENICILLIN G BENZATHINE INJ"]
["AARP UHC MEDICARE COMPLETE","60793-0702-10 - PR PENICILLIN G BENZATHINE INJ"]
["AARP UHC MEDICARE COMPLETE","61269-0410-20 - PR ETOPOSIDE 10 MG INJ"]
["AARP UHC MEDICARE COMPLETE","61314-0318-01 - PR INJECTION, ZARXIO"]
["AARP UHC MEDICARE COMPLETE","61314-0318-05 - PR INJECTION, ZARXIO"]
["AARP UHC MEDICARE COMPLETE","61314-0318-10 - PR INJECTION, ZARXIO"]
["AARP UHC MEDICARE COMPLETE","61314-0326-01 - PR INJECTION, ZARXIO"]
["AARP UHC MEDICARE COMPLETE","61314-0326-05 - PR INJECTION, ZARXIO"]
["AARP UHC MEDICARE COMPLETE","61314-0326-10 - PR INJECTION, ZARXIO"]
["AARP UHC MEDICARE COMPLETE","61553-0606-53 - PR FENTANYL CITRATE INJECITON"]
["AARP UHC MEDICARE COMPLETE","61553-0953-75 - PR INJ HEPARIN SODIUM PER 10 U"]
["AARP UHC MEDICARE COMPLETE","61703-0339-18 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","61703-0339-22 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","61703-0339-50 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","61703-0339-56 - PR CARBOPLATIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","61703-0342-22 - PR PACLITAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","61703-0342-50 - PR PACLITAXEL INJECTION"]
["AARP UHC MEDICARE COMPLETE","61703-0349-09 - PR IRINOTECAN INJECTION"]
["AARP UHC MEDICARE COMPLETE","61703-0363-18 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","61703-0363-22 - PR OXALIPLATIN"]
["AARP UHC MEDICARE COMPLETE","61755-0005-01 - PR AFLIBERCEPT INJECTION"]
["AARP UHC MEDICARE COMPLETE","61755-0008-01 - PR INJ., CEMIPLIMAB-RWLC, 1 MG"]
["AARP UHC MEDICARE COMPLETE","61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"]
["AARP UHC MEDICARE COMPLETE","61958-3002-01 - LENACAPAVIR 309 MG/ML SUBCUTANEOUS SOLUTION"]
["AARP UHC MEDICARE COMPLETE","61990-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["AARP UHC MEDICARE COMPLETE","61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["AARP UHC MEDICARE COMPLETE","62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"]
["AARP UHC MEDICARE COMPLETE","62332-0751-50 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","62756-0348-44 - PR OCTREOTIDE INJ, NON-DEPOT"]
["AARP UHC MEDICARE COMPLETE","62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"]
["AARP UHC MEDICARE COMPLETE","62756-0529-40 - PR INJ DESMOPRESSIN ACETATE"]
["AARP UHC MEDICARE COMPLETE","62856-0212-01 - PR INJ, LECANEMAB-IRMB, 1 MG"]
["AARP UHC MEDICARE COMPLETE","62856-0215-01 - PR INJ, LECANEMAB-IRMB, 1 MG"]
["AARP UHC MEDICARE COMPLETE","62856-0389-01 - PR INJECTION ERIBULIN MESYLATE 0.1 MG"]
["AARP UHC MEDICARE COMPLETE","62935-0221-04 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","62935-0223-05 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","62935-0227-10 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","62935-0453-45 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","62935-0461-50 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","62935-0756-80 - PR LEUPROLIDE ACETATE SUSPNSION"]
["AARP UHC MEDICARE COMPLETE","63261-0250-21 - PR VISUALIZATION ADJUNCT"]
["AARP UHC MEDICARE COMPLETE","63323-0012-03 - PR OXYTOCIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0012-10 - PR OXYTOCIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0013-01 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","63323-0013-02 - PR THIAMINE HCL 100 MG"]
["AARP UHC MEDICARE COMPLETE","63323-0024-25 - PR MANNITOL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0044-00 - PR VITAMIN B12 INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0044-01 - PR VITAMIN B12 INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0047-01 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","63323-0047-10 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","63323-0064-01 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","63323-0064-02 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","63323-0064-04 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","63323-0064-10 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","63323-0103-51 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0103-64 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0103-65 - PR CISPLATIN 10 MG INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0104-05 - PR ETOPOSIDE 10 MG INJ"]
["AARP UHC MEDICARE COMPLETE","63323-0104-25 - PR ETOPOSIDE 10 MG INJ"]
["AARP UHC MEDICARE COMPLETE","63323-0104-50 - PR ETOPOSIDE 10 MG INJ"]
["AARP UHC MEDICARE COMPLETE","63323-0106-00 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","63323-0106-05 - PR INJ MAGNESIUM SULFATE"]
["AARP UHC MEDICARE COMPLETE","63323-0117-01 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0117-10 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0117-20 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0117-51 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0117-61 - PR FLUOROURACIL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0125-53 - PR GEMCITABINE HCL"]
["AARP UHC MEDICARE COMPLETE","63323-0161-01 - PR KETOROLAC TROMETHAMINE INJ"]
["AARP UHC MEDICARE COMPLETE","63323-0162-01 - PR KETOROLAC TROMETHAMINE INJ"]
["AARP UHC MEDICARE COMPLETE","63323-0165-01 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","63323-0165-03 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","63323-0165-05 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","63323-0165-30 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","63323-0203-01 - PR VANCOMYCIN HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0229-05 - PR INJ PROTAMINE SULFATE/10 MG"]
["AARP UHC MEDICARE COMPLETE","63323-0229-30 - PR INJ PROTAMINE SULFATE/10 MG"]
["AARP UHC MEDICARE COMPLETE","63323-0262-03 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","63323-0262-11 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","63323-0276-02 - HEPARIN  PORCINE (PF) 1 000 UNIT/ML INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","63323-0278-10 - PR VINBLASTINE SULFATE INJ"]
["AARP UHC MEDICARE COMPLETE","63323-0280-03 - PR FUROSEMIDE INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0284-20 - PR VANCOMYCIN HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0286-09 - PR ROPIVACAINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0286-11 - PR ROPIVACAINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0286-35 - PR ROPIVACAINE HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0318-01 - PR GRANISETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0326-20 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0340-20 - PR CEFEPIME HCL FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0346-10 - PR CEFTRIAXONE SODIUM INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0355-60 - PR LEVOFLOXACIN INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0360-01 - PR INJ, CALCIUM GLUCONATE, NOS 10 MG"]
["AARP UHC MEDICARE COMPLETE","63323-0360-03 - PR INJ, CALCIUM GLUCONATE, NOS 10 MG"]
["AARP UHC MEDICARE COMPLETE","63323-0360-19 - PR INJ, CALCIUM GLUCONATE, NOS 10 MG"]
["AARP UHC MEDICARE COMPLETE","63323-0365-01 - PR OCTREOTIDE INJ, NON-DEPOT"]
["AARP UHC MEDICARE COMPLETE","63323-0368-20 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["AARP UHC MEDICARE COMPLETE","63323-0369-20 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["AARP UHC MEDICARE COMPLETE","63323-0373-02 - PR ONDANSETRON HCL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0376-00 - PR OCTREOTIDE INJ, NON-DEPOT"]
["AARP UHC MEDICARE COMPLETE","63323-0376-01 - PR OCTREOTIDE INJ, NON-DEPOT"]
["AARP UHC MEDICARE COMPLETE","63323-0377-01 - PR OCTREOTIDE INJ, NON-DEPOT"]
["AARP UHC MEDICARE COMPLETE","63323-0379-05 - PR OCTREOTIDE INJ, NON-DEPOT"]
["AARP UHC MEDICARE COMPLETE","63323-0398-10 - PR AZITHROMYCIN"]
["AARP UHC MEDICARE COMPLETE","63323-0401-20 - AZTREONAM 1 GRAM SOLUTION FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0402-20 - AZTREONAM 2 GRAM SOLUTION FOR INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0407-03 - PR CAFFEINE CITRATE INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0411-25 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","63323-0412-13 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["AARP UHC MEDICARE COMPLETE","63323-0464-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","63323-0464-17 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","63323-0464-31 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","63323-0464-37 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","63323-0466-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","63323-0466-37 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","63323-0469-01 - PR HALOPERIDOL DECANOATE INJ"]
["AARP UHC MEDICARE COMPLETE","63323-0472-17 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AARP UHC MEDICARE COMPLETE","63323-0474-00 - PR HALOPERIDOL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0474-01 - PR HALOPERIDOL INJECTION"]
["AARP UHC MEDICARE COMPLETE","63323-0477-27 - CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","63323-0478-27 - CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION"]
["AARP UHC MEDICARE COMPLETE","63323-0506-01 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","63323-0507-20 - PR MEROPENEM"]
["AARP UHC MEDICARE COMPLETE","63323-0508-30 - PR MEROPENEM"]
["AARP UHC MEDICARE COMPLETE","63323-0516-10 - PR DEXAMETHASONE SODIUM PHOS"]
["AARP UHC MEDICARE COMPLETE","63323-0519-02 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","63323-0523-01 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","63323-0533-01 - PR INJ ENOXAPARIN SODIUM"]
["AARP UHC MEDICARE COMPLETE","63323-0540-11 - PR INJ HEPARIN SODIUM PER 1000U"]
["AARP UHC MEDICARE COMPLETE","63323-0557-01 - PR INJ HEPARIN SODIUM PER 10 U"]
["AARP UHC MEDICARE COMPLETE","63323-0562-10 - PR BIVALIRUDIN"]
["AARP UHC MEDICARE COMPLETE","68084-0450-01 - PR TACROLIMUS ORAL PER 1 MG"]
["AARP UHC MEDICARE COMPLETE","70069-0301-10 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["AETNA","00003-2570-16 - AZTREONAM 2 GRAM SOLUTION FOR INJECTION"]
["AETNA","00054-0244-25 - HC 250 SHELL"]
["AETNA","00071-1012-68 - HC 250 SHELL"]
["AETNA","00121-0678-16 - HC 250 SHELL"]
["AETNA","00168-0006-80 - HC 250 SHELL"]
["AETNA","00378-3547-52 - PR ORAL PRESCRIPTION DRUG CHEMO"]
["AETNA","00406-9012-76 - HC 250 SHELL"]
["AETNA","00409-4887-50 - HC 250 SHELL"]
["AETNA","00574-0304-16 - HC 250 SHELL"]
["AETNA","00641-6167-01 - PR AMIKACIN SULFATE INJECTION"]
["AETNA","00781-5438-20 - HC 250 SHELL"]
["AETNA","00944-2716-05 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["AETNA","13533-0800-24 - HC 636 SHELL"]
["AETNA","25021-0801-66 - PR ZOLDERONIC ACID 1MG"]
["AETNA","31722-0532-01 - HC 250 SHELL"]
["AETNA","42858-0304-16 - HC 250 SHELL"]
["AETNA","49884-0054-01 - HC 250 SHELL"]
["AETNA","50268-0816-11 - HC 250 SHELL"]
["AETNA","51079-0870-20 - HC 250 SHELL"]
["AETNA","54288-0164-01 - PR CARBOPLATIN INJECTION"]
["AETNA","55150-0219-10 - PR EPTIFIBATIDE INJECTION"]
["AETNA","59762-5027-01 - HC 250 SHELL"]
["AETNA","60505-0798-00 - PR INJ ENOXAPARIN SODIUM"]
["AETNA","60687-0631-11 - HC 250 SHELL"]
["AETNA","63323-0013-01 - PR THIAMINE HCL 100 MG"]
["AETNA","63323-0489-02 - HC 250 SHELL"]
["AETNA","65162-0698-90 - HC 250 SHELL"]
["AETNA","67457-0852-00 - HC 250 SHELL"]
["AETNA","68084-0106-09 - HC 250 SHELL"]
["AETNA","69238-1544-01 - HC 250 SHELL"]
["AETNA","70710-1009-02 - HC 250 SHELL"]
["AETNA","70860-0700-02 - PR KETOROLAC TROMETHAMINE INJ"]
["AETNA","85446-0369-91 - HC 250 SHELL"]
["AETNA","99999-9900-72 - HC 250 SHELL"]
["AETNA","99999-9996-24 - HC 636 SHELL"]
["AETNA MEDICARE MANAGED","00054-8724-25 - PR PREDNISONE IR OR DR ORAL 1MG"]
["AETNA MEDICARE MANAGED","00409-2344-02 - PR INJ DOBUTAMINE HCL/250 MG"]
["AETNA MEDICARE MANAGED","00517-0901-01 - PR HYDRALAZINE HCL INJECTION"]
["AETNA MEDICARE MANAGED","36000-0324-01 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["AETNA MEDICARE MANAGED","55111-0526-01 - PR TACROLIMUS ORAL PER 1 MG"]
["AETNA MEDICARE MANAGED","55513-0032-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["AETNA MEDICARE MANAGED","63323-0472-17 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["AETNA MEDICARE MANAGED","66658-0234-07 - PR UNCLASSIFIED BIOLOGICS"]
["AETNA MEDICARE MANAGED","70121-1049-02 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS","00009-7686-01 - PR ALPROSTADIL FOR INJECTION"]
["BCBS","00074-3683-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["BCBS","00409-9158-01 - PR VITAMIN K PHYTONADIONE INJ"]
["BCBS","00703-0241-01 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS","09994-0891-83 - PR AZATHIOPRINE ORAL 50MG"]
["BCBS","48102-0047-20 - PR ORAL DEXAMETHASONE"]
["BCBS","51991-0735-99 - PR GRANISETRON HCL 1 MG ORAL"]
["BCBS","63261-0250-21 - PR VISUALIZATION ADJUNCT"]
["BCBS","63323-0616-03 - PR AMIODARONE HCL"]
["BCBS","67457-0824-15 - PR INJ, VANCOMYCIN HCL (MYLAN)"]
["BCBS","76204-0900-01 - PR LEVALBUTEROL NON-COMP UNIT"]
["BCBS MEDICARE MANAGED","00003-2570-16 - AZTREONAM 2 GRAM SOLUTION FOR INJECTION"]
["BCBS MEDICARE MANAGED","00143-9398-01 - PR ERTAPENEM INJECTION"]
["BCBS MEDICARE MANAGED","00548-5400-00 - PR MEDROXYPROGESTERONE ACETATE"]
["BCBS MEDICARE MANAGED","00781-3158-94 - PR BIVALIRUDIN"]
["BCBS MEDICARE MANAGED","44567-0240-10 - PR CEFEPIME HCL FOR INJECTION"]
["BCBS MEDICARE MANAGED","55150-0193-30 - PR ADENOSINE INJ 1MG"]
["BCBS MEDICARE MANAGED","60505-6180-05 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["BCBS MEDICARE MANAGED","67457-0217-20 - PR METHADONE INJECTION"]
["BCBS MEDICARE MANAGED","68084-0918-25 - PR MYCOPHENOLIC ACID"]
["BCBS MEDICARE MANAGED","72266-0123-01 - PR ONDANSETRON HCL INJECTION"]
["BCBS OUT OF STATE","00078-0825-81 - PR OCTREOTIDE INJECTION, DEPOT"]
["BCBS OUT OF STATE","00264-4204-52 - PR INJ MAGNESIUM SULFATE"]
["BCBS OUT OF STATE","00469-3250-10 - PR MICAFUNGIN SODIUM INJECTION"]
["BCBS OUT OF STATE","00944-2511-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["BCBS OUT OF STATE","25021-0230-05 - PR IRINOTECAN INJECTION"]
["BCBS OUT OF STATE","55111-0680-02 - PR FONDAPARINUX SODIUM"]
["BCBS OUT OF STATE","55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"]
["BCBS OUT OF STATE","63323-0286-09 - PR ROPIVACAINE HCL INJECTION"]
["BCBS OUT OF STATE","67457-0349-10 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["BCBS OUT OF STATE","70121-1396-01 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["BCBS OUT OF STATE","71288-0433-82 - PR INJ ENOXAPARIN SODIUM"]
["CCA","00069-0305-01 - PR INJ., TRAZIMERA, 10 MG"]
["CCA","00409-1160-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["CCA","00409-6653-05 - PR INJ POTASSIUM CHLORIDE"]
["CCA","16729-0276-11 - PR FLUOROURACIL INJECTION"]
["CCA","50242-0087-01 - PR INJ, ADO-TRASTUZUMAB EMT 1MG"]
["CCA","59762-2198-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["CCA","63323-0284-20 - PR VANCOMYCIN HCL INJECTION"]
["CCA","63459-0104-50 - PR INJ TRUXIMA 10 MG"]
["CCA","70436-0120-80 - PR LEUCOVORIN CALCIUM INJECTION"]
["CCA MEDICARE PREFERRED","00003-0293-20 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA MEDICARE PREFERRED","00074-3641-03 - PR LEUPROLIDE ACETATE /3.75 MG"]
["CCA MEDICARE PREFERRED","00409-9093-32 - PR FENTANYL CITRATE INJECITON"]
["CCA MEDICARE PREFERRED","00944-2700-05 - PR GAMMAGARD LIQUID INJECTION"]
["CCA MEDICARE PREFERRED","44567-0701-25 - PR CEFTRIAXONE SODIUM INJECTION"]
["CCA MEDICARE PREFERRED","55150-0332-01 - PR OXALIPLATIN"]
["CCA MEDICARE PREFERRED","59676-0320-00 - PR EPOETIN ALFA, NON-ESRD"]
["CCA MEDICARE PREFERRED","63323-0360-03 - PR INJ, CALCIUM GLUCONATE, NOS 10 MG"]
["CCA MEDICARE PREFERRED","69784-0002-06 - PR FLUCONAZOLE"]
["CCA MEDICARE PREFERRED","71288-0113-10 - PR GEMCITABINE HCL"]
["CIGNA","00054-0176-13 - PR BUPRENOPHONE ORAL 1 MG"]
["CIGNA","00069-1306-01 - PR INJ RETACRIT NON-ESRD USE"]
["CIGNA","00121-0595-16 - HC 250 SHELL"]
["CIGNA","00143-9981-50 - HC 250 SHELL"]
["CIGNA","00228-2781-11 - HC 250 SHELL"]
["CIGNA","00338-6010-48 - PR INJ MILRINONE LACTATE / 5 MG"]
["CIGNA","00409-4520-30 - PR INJ HEPARIN SODIUM PER 1000U"]
["CIGNA","00409-9094-31 - PR FENTANYL CITRATE INJECITON"]
["CIGNA","00641-6125-01 - PR MORPHINE SULFATE INJECTION"]
["CIGNA","00781-1962-60 - HC 250 SHELL"]
["CIGNA","00944-2700-05 - PR GAMMAGARD LIQUID INJECTION"]
["CIGNA","13273-0210-03 - HC 250 SHELL"]
["CIGNA","16729-0295-34 - PR CARBOPLATIN INJECTION"]
["CIGNA","25021-0230-05 - PR IRINOTECAN INJECTION"]
["CIGNA","42367-0540-32 - HC 250 SHELL"]
["CIGNA","44206-0452-91 - PR HIZENTRA INJECTION"]
["CIGNA","50268-0755-11 - HC 250 SHELL"]
["CIGNA","51079-0075-01 - HC 250 SHELL"]
["CIGNA","51079-0733-01 - HC 250 SHELL"]
["CIGNA","55150-0193-30 - PR ADENOSINE INJ 1MG"]
["CIGNA","55513-0956-01 - PANITUMUMAB INJECTION"]
["CIGNA","59762-0074-01 - HC 250 SHELL"]
["CIGNA","60687-0437-01 - HC 250 SHELL"]
["CIGNA","61314-0144-05 - HC 250 SHELL"]
["CIGNA","62756-0711-86 - HC 250 SHELL"]
["CIGNA","63739-0086-10 - HC 250 SHELL"]
["CIGNA","64980-0406-03 - HC 250 SHELL"]
["CIGNA","68084-0027-11 - HC 250 SHELL"]
["CIGNA","68084-0708-95 - HC 250 SHELL"]
["CIGNA","68982-0261-02 - HUMAN PROTHROMBIN CMPLX CONCENTRATE (PCC)-LANS 1 000 UNIT IV SOLUTION"]
["CIGNA","70127-0100-01 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["CIGNA","71506-0027-58 - HC 250 SHELL"]
["CIGNA","80681-0058-00 - HC 250 SHELL"]
["CIGNA","99999-9996-08 - HC 250 SHELL"]
["CORRECTIONS","00009-7376-11 - PR MEDROXYPROGESTERONE ACETATE"]
["CORRECTIONS","00409-2305-16 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["CORRECTIONS","00517-0020-10 - PR CAFFEINE CITRATE INJECTION"]
["CORRECTIONS","00904-7237-61 - PR DIPHENHYDRAMINE HCL 50MG"]
["CORRECTIONS","25021-0401-02 - HEPARIN  PORCINE (PF) 1 000 UNIT/ML INJECTION SOLUTION"]
["CORRECTIONS","55111-0652-07 - PR BIVALIRUDIN"]
["CORRECTIONS","59762-4538-02 - PR MEDROXYPROGESTERONE ACETATE"]
["CORRECTIONS","65862-0641-63 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["CORRECTIONS","69452-0350-60 - PR GRANISETRON HCL 1 MG ORAL"]
["FALLON","00004-0261-29 - PR MYCOPHENOLATE MOFETIL ORAL"]
["FALLON","00037-0431-01 - HC 250 SHELL"]
["FALLON","00069-4210-30 - HC 250 SHELL"]
["FALLON","00121-1154-00 - HC 250 SHELL"]
["FALLON","00143-9982-50 - HC 250 SHELL"]
["FALLON","00264-5535-32 - PR INJ, METRONIDAZOLE, 10 MG"]
["FALLON","00409-0528-23 - PR LEVOFLOXACIN INJECTION"]
["FALLON","00409-4928-34 - HC 250 SHELL"]
["FALLON","00517-0020-10 - PR CAFFEINE CITRATE INJECTION"]
["FALLON","00641-1495-35 - PR PROMETHAZINE HCL INJECTION"]
["FALLON","00832-0465-15 - HC 250 SHELL"]
["FALLON","00944-3053-02 - PR FACTOR VIII RECOMBINANT NOS"]
["FALLON","10147-1700-03 - HC 250 SHELL"]
["FALLON","20555-0001-00 - HC 250 SHELL"]
["FALLON","36000-0046-24 - PR LEVOFLOXACIN INJECTION"]
["FALLON","43066-0031-01 - HC 250 SHELL"]
["FALLON","44567-0620-01 - PR CALCIUM GLUCON (WG CRITICAL)"]
["FALLON","50268-0522-15 - HC 250 SHELL"]
["FALLON","51079-0205-20 - HC 250 SHELL"]
["FALLON","52244-0100-10 - HC 250 SHELL"]
["FALLON","54879-0001-00 - HC 250 SHELL"]
["FALLON","57237-0174-01 - HC 250 SHELL"]
["FALLON","60687-0206-01 - HC 250 SHELL"]
["FALLON","60687-0672-11 - HC 250 SHELL"]
["FALLON","63010-0027-70 - HC 250 SHELL"]
["FALLON","63323-0523-01 - PR INJ HEPARIN SODIUM PER 1000U"]
["FALLON","63739-0645-10 - HC 250 SHELL"]
["FALLON","67457-0266-10 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["FALLON","67457-0617-30 - PR GEMCITABINE HCL"]
["FALLON","68084-0844-11 - HC 250 SHELL"]
["FALLON","70069-0121-01 - HC 250 SHELL"]
["FALLON","70954-0492-10 - HC 250 SHELL"]
["FALLON","78206-0118-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["FALLON","99999-9900-84 - HC 250 SHELL"]
["FALLON","99999-9996-34 - HC 250 SHELL"]
["FALLON MEDICARE MANAGED","00143-9721-01 - PR LEVOFLOXACIN INJECTION"]
["FALLON MEDICARE MANAGED","00409-6729-23 - PR INJ MAGNESIUM SULFATE"]
["FALLON MEDICARE MANAGED","00517-2325-10 - PR IRON SUCROSE INJECTION"]
["FALLON MEDICARE MANAGED","25021-0233-20 - PR OXALIPLATIN"]
["FALLON MEDICARE MANAGED","50242-0041-64 - PR ALTEPLASE RECOMBINANT"]
["FALLON MEDICARE MANAGED","55150-0169-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["FALLON MEDICARE MANAGED","61703-0342-22 - PR PACLITAXEL INJECTION"]
["FALLON MEDICARE MANAGED","66993-0371-79 - PR MEDROXYPROGESTERONE ACETATE"]
["FALLON MEDICARE MANAGED","73594-9310-01 - PR INJECTION FE DERISOMALTOSE 10 MG"]
["FALLON SCO","00054-0383-25 - PR CYCLOPHOSPHAMIDE ORAL 25 MG"]
["FALLON SCO","00409-0182-01 - PR GEMCITABINE HCL"]
["FALLON SCO","00409-2308-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["FALLON SCO","00955-1006-10 - PR INJ ENOXAPARIN SODIUM"]
["FALLON SCO","25021-0136-10 - PR AMPICILLIN 500 MG INJ"]
["FALLON SCO","49702-0240-15 - PR INJECTION, CABOTEGRAVIR AND RILPIVIRINE, 2MG/3MG"]
["FALLON SCO","60505-6196-00 - PR ERTAPENEM INJECTION"]
["FALLON SCO","63323-0106-05 - PR INJ MAGNESIUM SULFATE"]
["FALLON SCO","70700-0169-22 - PR IRINOTECAN INJECTION"]
["FALLON SCO","99999-1307-91 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["HARVARD PILGRIM HEALTH CARE","00009-3701-05 - PR ALPROSTADIL FOR INJECTION"]
["HARVARD PILGRIM HEALTH CARE","00409-1162-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["HARVARD PILGRIM HEALTH CARE","00409-6629-02 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["HARVARD PILGRIM HEALTH CARE","16729-0275-67 - PR BIVALIRUDIN"]
["HARVARD PILGRIM HEALTH CARE","36000-0046-24 - PR LEVOFLOXACIN INJECTION"]
["HARVARD PILGRIM HEALTH CARE","50242-0145-01 - PR INJECTION, PERTUZUMAB, 1 MG"]
["HARVARD PILGRIM HEALTH CARE","61314-0318-01 - PR INJECTION, ZARXIO"]
["HARVARD PILGRIM HEALTH CARE","63323-0360-03 - PR INJ, CALCIUM GLUCONATE, NOS 10 MG"]
["HARVARD PILGRIM HEALTH CARE","65597-0406-01 - PR INJ FAM-TRASTU DERU-NXKI 1MG"]
["HARVARD PILGRIM HEALTH CARE","71288-0403-11 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["HARVARD PILGRIM HEALTH CARE","81952-0112-09 - HEPARIN (PORCINE) 1 000 UNIT/ML INJECTION SOLUTION"]
["HEALTH PLANS INC","00143-9721-01 - PR LEVOFLOXACIN INJECTION"]
["HEALTH PLANS INC","00409-2308-02 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["HEALTH PLANS INC","00548-5400-00 - PR MEDROXYPROGESTERONE ACETATE"]
["HEALTH PLANS INC","25021-0223-20 - PR CYTARABINE HCL 100 MG INJ"]
["HEALTH PLANS INC","43598-0050-25 - PR THIAMINE HCL 100 MG"]
["HEALTH PLANS INC","51991-0735-20 - PR GRANISETRON HCL 1 MG ORAL"]
["HEALTH PLANS INC","62756-0351-44 - PR OCTREOTIDE INJ, NON-DEPOT"]
["HEALTH PLANS INC","63323-0373-02 - PR ONDANSETRON HCL INJECTION"]
["HEALTH PLANS INC","68462-0470-54 - INJ, BUMETANIDE, 0.5 MG"]
["HEALTH PLANS INC","72266-0253-01 - PR CISPLATIN 10 MG INJECTION"]
["HPHC MEDICARE MANAGED","00009-0746-30 - PR MEDROXYPROGESTERONE ACETATE"]
["HPHC MEDICARE MANAGED","00409-2308-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["HPHC MEDICARE MANAGED","00517-0031-25 - PR VITAMIN B12 INJECTION"]
["HPHC MEDICARE MANAGED","23155-0473-33 - PR FUROSEMIDE INJECTION"]
["HPHC MEDICARE MANAGED","49281-0123-65 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HPHC MEDICARE MANAGED","55513-0023-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["HPHC MEDICARE MANAGED","59762-3060-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["HPHC MEDICARE MANAGED","63833-0518-02 - PR FACTOR XIII ANTI-HEM FACTOR"]
["HPHC MEDICARE MANAGED","70092-1086-44 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["HSN","00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"]
["HSN","00025-2732-31 - HC 250 SHELL"]
["HSN","00078-0337-05 - HC 250 SHELL"]
["HSN","00121-0826-01 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN","00168-0099-30 - HC 250 SHELL"]
["HSN","00264-2304-00 - HC 250 SHELL"]
["HSN","00378-9116-93 - HC 250 SHELL"]
["HSN","00409-4888-10 - HC 250 SHELL"]
["HSN","00436-0672-16 - HC 250 SHELL"]
["HSN","00641-1397-35 - PR CHLORPROMAZINE HCL INJECTION"]
["HSN","00904-2725-61 - HC 250 SHELL"]
["HSN","00944-2803-03 - PR ALPHA 1 PROTEINASE INHIBITOR"]
["HSN","13668-0010-05 - HC 250 SHELL"]
["HSN","18029-0850-02 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN","25682-0001-01 - ECULIZUMAB INJECTION"]
["HSN","43063-0617-60 - HC 250 SHELL"]
["HSN","44567-0400-10 - PR MEROPENEM"]
["HSN","50268-0860-11 - HC 250 SHELL"]
["HSN","51079-0209-01 - HC 250 SHELL"]
["HSN","51991-0818-01 - HC 250 SHELL"]
["HSN","55150-0235-01 - HC 250 SHELL"]
["HSN","57237-0110-01 - HC 250 SHELL"]
["HSN","59762-3060-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["HSN","60687-0648-11 - HC 250 SHELL"]
["HSN","61314-0326-10 - PR INJECTION, ZARXIO"]
["HSN","63323-0507-20 - PR MEROPENEM"]
["HSN","63739-0569-10 - HC 250 SHELL"]
["HSN","65862-0496-47 - HC 250 SHELL"]
["HSN","68084-0185-01 - HC 250 SHELL"]
["HSN","68084-0782-11 - HC 250 SHELL"]
["HSN","69097-0533-02 - HC 250 SHELL"]
["HSN","70860-0406-41 - INJ, BUMETANIDE, 0.5 MG"]
["HSN","71546-0951-10 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["HSN","99999-9900-77 - HC 250 SHELL"]
["HSN","99999-9996-30 - HC 250 SHELL"]
["HSN BAD DEBT","00003-0893-21 - HC 250 SHELL"]
["HSN BAD DEBT","00074-1539-03 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN BAD DEBT","00093-0311-01 - HC 250 SHELL"]
["HSN BAD DEBT","00121-0873-16 - HC 250 SHELL"]
["HSN BAD DEBT","00228-2781-11 - HC 250 SHELL"]
["HSN BAD DEBT","00338-3410-24 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN BAD DEBT","00409-6729-23 - PR INJ MAGNESIUM SULFATE"]
["HSN BAD DEBT","00487-9601-01 - PR BUDESONIDE NON-COMP UNIT"]
["HSN BAD DEBT","00536-1277-80 - HC 250 SHELL"]
["HSN BAD DEBT","00904-0523-72 - HC 250 SHELL"]
["HSN BAD DEBT","00904-6519-61 - HC 250 SHELL"]
["HSN BAD DEBT","00944-2815-01 - PR ALPHA 1 PROTEINASE INHIBITOR"]
["HSN BAD DEBT","16729-0043-01 - PR TACROLIMUS ORAL PER 1 MG"]
["HSN BAD DEBT","25021-0166-48 - PR PIPERACILLIN/TAZOBACTAM"]
["HSN BAD DEBT","35573-0443-25 - PR LEVALBUTEROL NON-COMP UNIT"]
["HSN BAD DEBT","45802-0088-01 - HC 250 SHELL"]
["HSN BAD DEBT","50111-0648-03 - HC 250 SHELL"]
["HSN BAD DEBT","51079-0375-20 - HC 250 SHELL"]
["HSN BAD DEBT","51079-0810-01 - HC 250 SHELL"]
["HSN BAD DEBT","51991-0820-01 - HC 250 SHELL"]
["HSN BAD DEBT","55150-0319-25 - PR CHLORPROMAZINE HCL INJECTION"]
["HSN BAD DEBT","59676-0566-30 - HC 250 SHELL"]
["HSN BAD DEBT","60687-0178-11 - HC 250 SHELL"]
["HSN BAD DEBT","61703-0339-22 - PR CARBOPLATIN INJECTION"]
["HSN BAD DEBT","63304-0583-60 - HC 250 SHELL"]
["HSN BAD DEBT","64067-0216-01 - HC 250 SHELL"]
["HSN BAD DEBT","65250-0266-04 - PR INJ, BUPIVACAINE LIPOSOME"]
["HSN BAD DEBT","67457-0228-10 - HC 250 SHELL"]
["HSN BAD DEBT","68094-0764-62 - HC 250 SHELL"]
["HSN BAD DEBT","69238-1544-01 - HC 250 SHELL"]
["HSN BAD DEBT","70069-0013-01 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["HSN BAD DEBT","72319-0006-02 - HC 250 SHELL"]
["HSN BAD DEBT","87701-0425-67 - HC 250 SHELL"]
["HSN BAD DEBT","99999-9900-62 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00002-7669-01 - PR CHEMOTHERAPY DRUG"]
["HSN CONFIDENTIAL","00054-0019-20 - PR PREDNISONE IR OR DR ORAL 1MG"]
["HSN CONFIDENTIAL","00093-2165-68 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00121-0678-16 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00143-9853-16 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00378-0873-16 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00409-1390-51 - PR MEROPENEM"]
["HSN CONFIDENTIAL","00409-4755-18 - PR ONDANSETRON HCL INJECTION"]
["HSN CONFIDENTIAL","00555-0071-01 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00641-6046-10 - PR LORAZEPAM INJECTION"]
["HSN CONFIDENTIAL","00904-6666-61 - HC 250 SHELL"]
["HSN CONFIDENTIAL","00904-7363-61 - HC 250 SHELL"]
["HSN CONFIDENTIAL","11788-0010-01 - HC 250 SHELL"]
["HSN CONFIDENTIAL","25021-0401-02 - HEPARIN  PORCINE (PF) 1 000 UNIT/ML INJECTION SOLUTION"]
["HSN CONFIDENTIAL","38779-0884-08 - HC 250 SHELL"]
["HSN CONFIDENTIAL","45802-0465-64 - HC 250 SHELL"]
["HSN CONFIDENTIAL","50242-0074-01 - HC 637 SHELL"]
["HSN CONFIDENTIAL","50268-0644-15 - HC 250 SHELL"]
["HSN CONFIDENTIAL","51079-0926-20 - HC 250 SHELL"]
["HSN CONFIDENTIAL","51645-0991-01 - HC 250 SHELL"]
["HSN CONFIDENTIAL","55150-0168-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["HSN CONFIDENTIAL","59762-3060-02 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["HSN CONFIDENTIAL","60687-0328-33 - HC 250 SHELL"]
["HSN CONFIDENTIAL","61314-0643-05 - HC 250 SHELL"]
["HSN CONFIDENTIAL","63323-0130-11 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN CONFIDENTIAL","63323-0466-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["HSN CONFIDENTIAL","65862-0201-90 - HC 250 SHELL"]
["HSN CONFIDENTIAL","67877-0264-90 - HC 250 SHELL"]
["HSN CONFIDENTIAL","68001-0475-47 - HC 250 SHELL"]
["HSN CONFIDENTIAL","69097-0642-02 - HC 250 SHELL"]
["HSN CONFIDENTIAL","70121-1454-01 - PR MEROPENEM"]
["HSN CONFIDENTIAL","70860-0211-41 - PR INJECTION, FULVESTRANT"]
["HSN CONFIDENTIAL","76329-1240-01 - PR VITAMIN K PHYTONADIONE INJ"]
["HSN CONFIDENTIAL","99999-9342-70 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["HSN DENTAL","00004-0259-01 - PR MYCOPHENOLATE MOFETIL ORAL"]
["HSN DENTAL","00054-0622-63 - HC 250 SHELL"]
["HSN DENTAL","00087-0405-89 - HC 250 SHELL"]
["HSN DENTAL","00093-2210-01 - HC 250 SHELL"]
["HSN DENTAL","00168-0202-30 - HC 250 SHELL"]
["HSN DENTAL","00264-4460-30 - HC 250 SHELL"]
["HSN DENTAL","00378-3950-77 - HC 250 SHELL"]
["HSN DENTAL","00409-4911-34 - PR ATROPINE SULFATE INJECTION"]
["HSN DENTAL","00574-4024-11 - HC 250 SHELL"]
["HSN DENTAL","00703-3213-01 - PR PACLITAXEL INJECTION"]
["HSN DENTAL","00904-6291-61 - HC 250 SHELL"]
["HSN DENTAL","00904-6667-61 - HC 250 SHELL"]
["HSN DENTAL","13668-0091-90 - HC 250 SHELL"]
["HSN DENTAL","19515-0814-52 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HSN DENTAL","40985-0223-68 - HC 250 SHELL"]
["HSN DENTAL","43066-0023-01 - PR ROPIVACAINE HCL INJECTION"]
["HSN DENTAL","45963-0343-02 - HC 250 SHELL"]
["HSN DENTAL","50419-0747-01 - HC 250 SHELL"]
["HSN DENTAL","51079-0443-20 - HC 250 SHELL"]
["HSN DENTAL","51079-0929-01 - HC 250 SHELL"]
["HSN DENTAL","55150-0259-30 - PR ACETYLCYSTEINE INJECTION"]
["HSN DENTAL","57237-0173-01 - HC 250 SHELL"]
["HSN DENTAL","60687-0273-21 - HC 250 SHELL"]
["HSN DENTAL","60687-0670-01 - HC 250 SHELL"]
["HSN DENTAL","61958-2201-01 - HC 250 SHELL"]
["HSN DENTAL","63323-0519-02 - PR INJ HEPARIN SODIUM PER 1000U"]
["HSN DENTAL","63807-0100-35 - HC 250 SHELL"]
["HSN DENTAL","65862-0202-30 - HC 250 SHELL"]
["HSN DENTAL","68084-0203-11 - HC 250 SHELL"]
["HSN DENTAL","68084-0844-01 - HC 250 SHELL"]
["HSN DENTAL","69097-0709-96 - PR VITAMIN K PHYTONADIONE INJ"]
["HSN DENTAL","71288-0200-11 - PR INJ MILRINONE LACTATE / 5 MG"]
["HSN DENTAL","73625-0113-11 - HC 250 SHELL"]
["HSN DENTAL","99999-9900-83 - HC 250 SHELL"]
["HSN DENTAL","99999-9996-33 - HC 250 SHELL"]
["HSN PARTIAL","00054-0018-25 - PR PREDNISONE IR OR DR ORAL 1MG"]
["HSN PARTIAL","00074-3399-30 - HC 250 SHELL"]
["HSN PARTIAL","00093-5031-56 - HC 250 SHELL"]
["HSN PARTIAL","00121-1154-00 - HC 250 SHELL"]
["HSN PARTIAL","00270-1411-11 - LOCM 200-299MG/ML IODINE,1ML"]
["HSN PARTIAL","00378-5430-35 - HC 250 SHELL"]
["HSN PARTIAL","00409-7299-73 - HC 250 SHELL"]
["HSN PARTIAL","00487-9801-01 - PR IPRATROPIUM BROMIDE NON-COMP"]
["HSN PARTIAL","00641-1397-31 - PR CHLORPROMAZINE HCL INJECTION"]
["HSN PARTIAL","00904-1882-60 - HC 250 SHELL"]
["HSN PARTIAL","00904-6861-61 - HC 250 SHELL"]
["HSN PARTIAL","00944-3053-02 - PR FACTOR VIII RECOMBINANT NOS"]
["HSN PARTIAL","16729-0500-08 - PR FUROSEMIDE INJECTION"]
["HSN PARTIAL","25682-0001-01 - ECULIZUMAB INJECTION"]
["HSN PARTIAL","43598-0213-50 - HC 250 SHELL"]
["HSN PARTIAL","47335-0736-86 - HC 250 SHELL"]
["HSN PARTIAL","50268-0061-15 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["HSN PARTIAL","51079-0387-20 - HC 250 SHELL"]
["HSN PARTIAL","51224-0206-30 - HC 250 SHELL"]
["HSN PARTIAL","52244-0100-10 - HC 250 SHELL"]
["HSN PARTIAL","55513-0057-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["HSN PARTIAL","60432-0065-75 - HC 250 SHELL"]
["HSN PARTIAL","60687-0206-01 - HC 250 SHELL"]
["HSN PARTIAL","62559-0138-07 - HC 250 SHELL"]
["HSN PARTIAL","63323-0117-20 - PR FLUOROURACIL INJECTION"]
["HSN PARTIAL","64253-0444-25 - PR INJ HEPARIN SODIUM PER 10 U"]
["HSN PARTIAL","65862-0713-30 - HC 250 SHELL"]
["HSN PARTIAL","67457-0266-10 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["HSN PARTIAL","68084-0281-01 - HC 250 SHELL"]
["HSN PARTIAL","69238-2092-03 - HC 250 SHELL"]
["HSN PARTIAL","70069-0121-01 - HC 250 SHELL"]
["HSN PARTIAL","76329-3369-01 - HC 636 SHELL"]
["HSN PARTIAL","87701-0432-33 - HC 250 SHELL"]
["HSN PARTIAL","99999-9909-97 - HC 250 SHELL"]
["HUMANA MEDICARE","00069-0308-01 - PR INJ., TRAZIMERA, 10 MG"]
["HUMANA MEDICARE","00143-9721-01 - PR LEVOFLOXACIN INJECTION"]
["HUMANA MEDICARE","00409-2723-02 - HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION"]
["HUMANA MEDICARE","09999-4006-05 - PR VANCOMYCIN HCL INJECTION"]
["HUMANA MEDICARE","25021-0233-20 - PR OXALIPLATIN"]
["HUMANA MEDICARE","57894-0450-01 - TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION"]
["HUMANA MEDICARE","61314-0318-05 - PR INJECTION, ZARXIO"]
["HUMANA MEDICARE","63323-0474-00 - PR HALOPERIDOL INJECTION"]
["HUMANA MEDICARE","70860-0115-26 - PR AMPICILLIN 500 MG INJ"]
["HUMANA MEDICARE","73594-9310-01 - PR INJECTION FE DERISOMALTOSE 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00006-3603-61 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00071-0007-40 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00093-1024-06 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00187-5600-15 - PR VERTEPORFIN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00338-0023-03 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00378-1101-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00409-7517-16 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00517-0374-05 - PR VISUALIZATION ADJUNCT"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00591-0844-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00781-3407-78 - PR AMPICILLIN 500 MG INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","00904-6592-04 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","16729-0114-11 - PR ETOPOSIDE 10 MG INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","23155-0547-31 - PR ONDANSETRON HCL INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","31722-0308-01 - PR INJ. OLANZAPINE, 0.5MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","43598-0446-71 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","45802-0580-84 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","50111-0648-03 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","50474-0781-85 - HC 636 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","51079-0882-20 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","52817-0182-10 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","58160-0827-03 - HC 636 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","60505-0560-00 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","60687-0833-11 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","61958-0401-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","63323-0104-25 - PR ETOPOSIDE 10 MG INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","64679-0012-02 - PR PIPERACILLIN/TAZOBACTAM"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","66302-0350-10 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","67457-0390-54 - PR ZOLDERONIC ACID 1MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","68180-0401-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","69339-0148-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","70710-1008-02 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","72578-0090-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99400-8996-65 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99999-9997-80 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00006-4305-02 - PR INJECTION, RENFLEXIS"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00054-0189-13 - PR BUPRENORPH/NALOX 6.1 TO 10MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00093-3174-31 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00143-1171-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00172-5728-70 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00378-3017-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00409-1632-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00521-2384-00 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00574-0292-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00641-6126-25 - PR MORPHINE SULFATE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","00904-6773-61 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","09994-0900-39 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","24208-0585-59 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","31722-0525-90 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","39822-4200-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","46122-0575-78 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","49281-0574-15 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","50268-0764-11 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","51079-0966-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","53746-0544-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","57896-0901-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","60505-3275-00 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","60687-0387-11 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","62103-0333-04 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","63323-0203-01 - PR VANCOMYCIN HCL INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","63323-0462-01 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","65862-0534-50 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","67457-0781-08 - PR DOCETAXEL INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","68084-0097-11 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","68462-0756-01 - PR KETOROLAC TROMETHAMINE INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","70377-0081-11 - HC 250 SHELL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","76204-0022-60 - PR STERILE WATER/SALINE, 10 ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99994-0801-47 - PR AMPICILLIN 500 MG INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99999-9996-52 - PR METHADONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99999-9997-83 - HC 250 SHELL"]
["MEDICARE","00338-0357-03 - PR MANNITOL INJECTION"]
["MEDICARE","00409-2308-21 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["MEDICARE","00641-6253-01 - PR REGADENOSON INJECTION"]
["MEDICARE","36000-0282-25 - PR FUROSEMIDE INJECTION"]
["MEDICARE","55566-2200-00 - PR INJ DESMOPRESSIN ACETATE"]
["MEDICARE","63261-0250-21 - PR VISUALIZATION ADJUNCT"]
["MEDICARE","65757-0402-03 - PR INJECTION, ARIPIPRAZOLE LAUROXIL, (ARISTADA), 1 MG"]
["MEDICARE","67457-0824-15 - PR INJ, VANCOMYCIN HCL (MYLAN)"]
["MEDICARE","99999-1307-91 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["NEIGHBORHOOD PACE","00049-0014-83 - PR AMPICILLIN SULBACTAM 1.5 GM"]
["NEIGHBORHOOD PACE","00409-9094-41 - PR FENTANYL CITRATE INJECITON"]
["NEIGHBORHOOD PACE","00641-6061-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["NEIGHBORHOOD PACE","16729-0267-65 - PR DOCETAXEL INJECTION"]
["NEIGHBORHOOD PACE","51754-5060-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["NEIGHBORHOOD PACE","59676-0310-00 - PR EPOETIN ALFA, NON-ESRD"]
["NEIGHBORHOOD PACE","62064-0122-02 - PR INJ., IBALIZUMAB-UIYK, 10 MG"]
["NEIGHBORHOOD PACE","68001-0265-22 - PR ETOPOSIDE 10 MG INJ"]
["NEIGHBORHOOD PACE","70121-1754-01 - PR INJ ALYMSYS 10 MG"]
["OXFORD HEALTH","00069-3140-19 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["OXFORD HEALTH","00338-0077-03 - PR 5% DEXTROSE/NORMAL SALINE"]
["OXFORD HEALTH","00409-7332-11 - PR CEFTRIAXONE SODIUM INJECTION"]
["OXFORD HEALTH","16729-0472-30 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["OXFORD HEALTH","42747-0761-01 - PR INJ, MOGAMULIZUMAB-KPKC, 1 MG"]
["OXFORD HEALTH","50268-0787-11 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["OXFORD HEALTH","62856-0389-01 - PR INJECTION ERIBULIN MESYLATE 0.1 MG"]
["OXFORD HEALTH","63323-0407-03 - PR CAFFEINE CITRATE INJECTION"]
["OXFORD HEALTH","67457-0528-10 - PR LEUCOVORIN CALCIUM INJECTION"]
["OXFORD HEALTH","99999-9992-00 - PR ORAL DEXAMETHASONE"]
["SENIOR WHOLE HEALTH","00074-3473-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["SENIOR WHOLE HEALTH","00409-7620-49 - PR INJ HEPARIN SODIUM PER 1000U"]
["SENIOR WHOLE HEALTH","00641-6044-25 - PR LORAZEPAM INJECTION"]
["SENIOR WHOLE HEALTH","42023-0189-01 - PR NEOSTIGMINE METHYLSLFTE INJ"]
["SENIOR WHOLE HEALTH","51672-4091-03 - PR ONDANSETRON 1 MG, ORAL"]
["SENIOR WHOLE HEALTH","59676-0310-02 - PR EPOETIN ALFA, NON-ESRD"]
["SENIOR WHOLE HEALTH","61990-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["SENIOR WHOLE HEALTH","67979-0511-43 - PR TESTOSTERONE UNDECANOATE 1MG"]
["SENIOR WHOLE HEALTH","71288-0101-20 - PR OXALIPLATIN"]
["TRICARE EAST","00078-0734-61 - PR CANAKINUMAB INJECTION"]
["TRICARE EAST","00338-0077-03 - PR 5% DEXTROSE/NORMAL SALINE"]
["TRICARE EAST","00641-6028-25 - PR FENTANYL CITRATE INJECITON"]
["TRICARE EAST","16729-0500-08 - PR FUROSEMIDE INJECTION"]
["TRICARE EAST","44567-0421-00 - PR INJ MAGNESIUM SULFATE"]
["TRICARE EAST","51079-0519-01 - PR CHLORPROMAZINE HCL 5MG ORAL"]
["TRICARE EAST","61703-0363-18 - PR OXALIPLATIN"]
["TRICARE EAST","63833-0528-01 - PR FACTOR XIII ANTI-HEM FACTOR"]
["TRICARE EAST","71336-1003-01 - PR INJECTION, VUTRISIRAN, 1 MG"]
["TRICARE FOR LIFE","00003-4522-11 - PR INJECTION, ELOTUZUMAB, 1MG"]
["TRICARE FOR LIFE","00143-9857-25 - PR CEFTRIAXONE SODIUM INJECTION"]
["TRICARE FOR LIFE","00469-0607-73 - PR TACROLIMUS ORAL PER 1 MG"]
["TRICARE FOR LIFE","00904-6985-20 - PR DIPHENHYDRAMINE HCL 50MG"]
["TRICARE FOR LIFE","16729-0332-03 - PR OXALIPLATIN"]
["TRICARE FOR LIFE","50242-0096-01 - INJ, FARICIMAB-SVOA, 0.1MG"]
["TRICARE FOR LIFE","59762-3140-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["TRICARE FOR LIFE","65862-0641-63 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["TRICARE FOR LIFE","70114-0101-01 - PR INJECTION, UDENYCA, 0.5 MG"]
["TRICARE FOR LIFE","72485-0504-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["TUFTS","00046-1100-81 - HC 250 SHELL"]
["TUFTS","00069-4494-02 - PR INJECT, ELRANATAMAB-BCMM, 1 MG"]
["TUFTS","00078-0818-81 - PR OCTREOTIDE INJECTION, DEPOT"]
["TUFTS","00121-1154-30 - HC 250 SHELL"]
["TUFTS","00264-7520-20 - HC 250 SHELL"]
["TUFTS","00338-0695-04 - PR INJ POTASSIUM CHLORIDE"]
["TUFTS","00409-5820-01 - PR DOPAMINE INJECTION"]
["TUFTS","00469-0520-02 - HC 250 SHELL"]
["TUFTS","00591-0407-01 - HC 250 SHELL"]
["TUFTS","00832-1211-01 - HC 250 SHELL"]
["TUFTS","00904-6376-61 - HC 250 SHELL"]
["TUFTS","00944-2514-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["TUFTS","23155-0026-01 - HC 250 SHELL"]
["TUFTS","25010-0210-27 - HC 250 SHELL"]
["TUFTS","43386-0312-08 - HC 250 SHELL"]
["TUFTS","44567-0620-24 - PR CALCIUM GLUCON (WG CRITICAL)"]
["TUFTS","49702-0223-18 - HC 250 SHELL"]
["TUFTS","51079-0211-01 - HC 250 SHELL"]
["TUFTS","51079-0721-20 - PR MYCOPHENOLATE MOFETIL ORAL"]
["TUFTS","51754-5060-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS","55566-8303-01 - PR DEGARELIX INJECTION"]
["TUFTS","59676-0278-01 - HC 250 SHELL"]
["TUFTS","60687-0691-01 - HC 250 SHELL"]
["TUFTS","61314-0643-05 - HC 250 SHELL"]
["TUFTS","62756-0707-86 - HC 250 SHELL"]
["TUFTS","63739-0984-10 - HC 250 SHELL"]
["TUFTS","65162-0698-90 - HC 250 SHELL"]
["TUFTS","67457-0162-02 - HC 250 SHELL"]
["TUFTS","68084-0480-01 - HC 250 SHELL"]
["TUFTS","68462-0404-44 - HC 250 SHELL"]
["TUFTS","71288-0101-10 - PR OXALIPLATIN"]
["TUFTS","72205-0101-07 - INJ, BUMETANIDE, 0.5 MG"]
["TUFTS","99980-9988-12 - HC 250 SHELL"]
["TUFTS","99999-9996-55 - HC 250 SHELL"]
["TUFTS","99999-9999-99 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00049-4910-30 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00074-6594-90 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00115-4211-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00338-0043-04 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00378-0181-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00409-1163-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["TUFTS CONNCARE/QHP","00409-9045-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00536-4406-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","00641-6019-10 - PR IN MORPHINE PRESERVATIV FREE"]
["TUFTS CONNCARE/QHP","00904-6617-61 - PR HYDROXYZINE PAMOATE 25MG"]
["TUFTS CONNCARE/QHP","08290-3064-24 - PR INJ HEPARIN SODIUM PER 10 U"]
["TUFTS CONNCARE/QHP","10702-0011-01 - PR HYDROXYZINE PAMOATE 25MG"]
["TUFTS CONNCARE/QHP","25021-0245-04 - PR DOCETAXEL INJECTION"]
["TUFTS CONNCARE/QHP","37864-0000-33 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","43598-0204-51 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","49281-0574-88 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["TUFTS CONNCARE/QHP","50268-0582-15 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","51079-0888-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","52244-0100-10 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","55150-0114-20 - PR AMPICILLIN 500 MG INJ"]
["TUFTS CONNCARE/QHP","59762-1307-02 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","60687-0273-11 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","60687-0648-11 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","62756-0797-88 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","63323-0462-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","65862-0062-01 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","66993-0409-32 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","68001-0428-00 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","69097-0127-05 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","70092-1452-44 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","73177-0146-33 - PR ALBUTEROL NON-COMP CON"]
["TUFTS CONNCARE/QHP","99940-8011-34 - HC 250 SHELL"]
["TUFTS CONNCARE/QHP","99999-9106-55 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["TUFTS MEDICARE","00009-7376-11 - PR MEDROXYPROGESTERONE ACETATE"]
["TUFTS MEDICARE","00075-0621-60 - PR INJ ENOXAPARIN SODIUM"]
["TUFTS MEDICARE","00409-1559-19 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["TUFTS MEDICARE","00944-2513-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["TUFTS MEDICARE","25021-0451-01 - PR OCTREOTIDE INJ, NON-DEPOT"]
["TUFTS MEDICARE","55150-0273-01 - PR THIAMINE HCL 100 MG"]
["TUFTS MEDICARE","61703-0342-50 - PR PACLITAXEL INJECTION"]
["TUFTS MEDICARE","63323-0340-20 - PR CEFEPIME HCL FOR INJECTION"]
["TUFTS MEDICARE","70092-1485-46 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["TUFTS MEDICARE","81284-0213-00 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["TUFTS MEDICARE","99999-9999-75 - PR FLUOROURACIL INJECTION"]
["TUFTS MEDICARE MANAGED","00409-1630-10 - PR ATROPINE SULFATE INJECTION"]
["TUFTS MEDICARE MANAGED","00641-1410-35 - PR DIGOXIN INJECTION"]
["TUFTS MEDICARE MANAGED","00904-5307-60 - PR DIPHENHYDRAMINE HCL 50MG"]
["TUFTS MEDICARE MANAGED","43598-0529-11 - PR NEOSTIGMINE METHYLSLFTE INJ"]
["TUFTS MEDICARE MANAGED","55150-0332-01 - PR OXALIPLATIN"]
["TUFTS MEDICARE MANAGED","63323-0373-02 - PR ONDANSETRON HCL INJECTION"]
["TUFTS MEDICARE MANAGED","67457-0423-00 - PR DEXAMETHASONE SODIUM PHOS"]
["TUFTS MEDICARE MANAGED","72266-0103-01 - PR INJ LABETALOL HCL HIKMA, 5MG"]
["TUFTS MEDICARE MANAGED","73475-3041-05 - EFGARTIGIMOD ALFA-FCAB 20 MG/ML INTRAVENOUS SOLUTION"]
["UBH HPHC","00143-9875-01 - PR AMIODARONE HCL"]
["UBH HPHC","00409-1165-02 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UBH HPHC","00641-6059-10 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["UBH HPHC","25021-0311-04 - PR FUROSEMIDE INJECTION"]
["UBH HPHC","55513-0021-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["UBH HPHC","61703-0339-22 - PR CARBOPLATIN INJECTION"]
["UBH HPHC","63807-0600-55 - PR INJ HEPARIN SODIUM PER 10 U"]
["UBH HPHC","67457-0217-20 - PR METHADONE INJECTION"]
["UBH HPHC","76329-8261-00 - PR LORAZEPAM INJECTION"]
["UNICARE","00002-7349-01 - HC 637 SHELL"]
["UNICARE","00054-0141-25 - HC 250 SHELL"]
["UNICARE","00093-2027-23 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["UNICARE","00121-4721-05 - HC 250 SHELL"]
["UNICARE","00338-0049-38 - HC 250 SHELL"]
["UNICARE","00378-9116-93 - HC 250 SHELL"]
["UNICARE","00409-1208-01 - HC 250 SHELL"]
["UNICARE","00517-1004-25 - PR ATROPINE SULFATE INJECTION"]
["UNICARE","00548-5701-00 - PR MEDROXYPROGESTERONE ACETATE"]
["UNICARE","00904-2725-61 - HC 250 SHELL"]
["UNICARE","00904-6640-61 - HC 250 SHELL"]
["UNICARE","05664-1198-50 - HC 250 SHELL"]
["UNICARE","24201-0201-01 - HC 250 SHELL"]
["UNICARE","25682-0001-01 - ECULIZUMAB INJECTION"]
["UNICARE","37864-0827-99 - HC 250 SHELL"]
["UNICARE","45802-0897-10 - HC 250 SHELL"]
["UNICARE","49401-0088-35 - PR BELIMUMAB INJECTION"]
["UNICARE","51079-0455-20 - HC 250 SHELL"]
["UNICARE","51293-0846-10 - HC 250 SHELL"]
["UNICARE","53436-0084-30 - HC 250 SHELL"]
["UNICARE","58468-0090-01 - PR SYNVISC OR SYNVISC-ONE"]
["UNICARE","59762-2198-03 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["UNICARE","60687-0695-11 - HC 250 SHELL"]
["UNICARE","61958-1501-01 - HC 250 SHELL"]
["UNICARE","63323-0120-20 - PR CYTARABINE HCL 100 MG INJ"]
["UNICARE","63323-0464-31 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UNICARE","65862-0496-47 - HC 250 SHELL"]
["UNICARE","67457-0438-00 - HC 250 SHELL"]
["UNICARE","68180-0659-07 - HC 250 SHELL"]
["UNICARE","69097-0517-07 - PR CYCLOPHOSPHAMIDE ORAL 25 MG"]
["UNICARE","70860-0406-41 - INJ, BUMETANIDE, 0.5 MG"]
["UNICARE","73535-0208-01 - TAFASITAMAB-CXIX 200 MG/5 ML IV (RECONSTITUTED VIAL)"]
["UNICARE","99980-9988-12 - HC 250 SHELL"]
["UNICARE","99999-9291-60 - HC 250 SHELL"]
["UNITED","00003-3734-13 - PR INJECTION, NIVOLUMAB"]
["UNITED","00143-9295-01 - PR HALOPERIDOL DECANOATE INJ"]
["UNITED","00409-9094-41 - PR FENTANYL CITRATE INJECITON"]
["UNITED","00703-0241-01 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED","23155-0290-41 - PR AMIKACIN SULFATE INJECTION"]
["UNITED","47335-0993-01 - PR INJ, METRONIDAZOLE, 10 MG"]
["UNITED","55150-0197-20 - PR ROPIVACAINE HCL INJECTION"]
["UNITED","57894-0450-01 - TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION"]
["UNITED","63323-0326-20 - PR CEFEPIME HCL FOR INJECTION"]
["UNITED","67457-0617-30 - PR GEMCITABINE HCL"]
["UNITED","76075-0103-01 - PR INJECTION, CARFILZOMIB, 1 MG"]
["UNITED COMMUNITY PLAN","00049-0530-28 - PR PENICILLIN G POTASSIUM INJ"]
["UNITED COMMUNITY PLAN","00187-5600-15 - PR VERTEPORFIN INJECTION"]
["UNITED COMMUNITY PLAN","00517-2340-01 - PR IRON SUCROSE INJECTION"]
["UNITED COMMUNITY PLAN","00944-2718-20 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["UNITED COMMUNITY PLAN","25021-0107-20 - PR CEFTRIAXONE SODIUM INJECTION"]
["UNITED COMMUNITY PLAN","55150-0170-30 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UNITED COMMUNITY PLAN","61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"]
["UNITED COMMUNITY PLAN","66993-0730-51 - PR ORAL DEXAMETHASONE"]
["UNITED COMMUNITY PLAN","70127-0100-10 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["UNITED COMMUNITY PLAN","72205-0101-01 - INJ, BUMETANIDE, 0.5 MG"]
["UNITED MEDICARE MANAGED","00069-0306-01 - PR INJ., TRAZIMERA, 10 MG"]
["UNITED MEDICARE MANAGED","00409-2308-02 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["UNITED MEDICARE MANAGED","00517-0032-25 - PR VITAMIN B12 INJECTION"]
["UNITED MEDICARE MANAGED","00944-2512-02 - PR HYQVIA 100MG IMMUNEGLOBULIN"]
["UNITED MEDICARE MANAGED","50242-0044-13 - PR ALTEPLASE RECOMBINANT"]
["UNITED MEDICARE MANAGED","55111-0525-01 - PR TACROLIMUS ORAL PER 1 MG"]
["UNITED MEDICARE MANAGED","63323-0464-31 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["UNITED MEDICARE MANAGED","65757-0403-03 - PR INJECTION, ARIPIPRAZOLE LAUROXIL, (ARISTADA), 1 MG"]
["UNITED MEDICARE MANAGED","70121-1579-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["UPHAMS CORNER ESP","00004-0038-22 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["UPHAMS CORNER ESP","00025-2742-31 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00069-3150-83 - PR AZITHROMYCIN"]
["UPHAMS CORNER ESP","00121-0654-16 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00143-9555-01 - PR LEUCOVORIN CALCIUM INJECTION"]
["UPHAMS CORNER ESP","00378-4276-77 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00409-0183-01 - PR GEMCITABINE HCL"]
["UPHAMS CORNER ESP","00409-4520-02 - PR INJ HEPARIN SODIUM PER 1000U"]
["UPHAMS CORNER ESP","00574-2008-15 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00641-1398-31 - PR CHLORPROMAZINE HCL INJECTION"]
["UPHAMS CORNER ESP","00781-8034-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","00904-7183-61 - HC 250 SHELL"]
["UPHAMS CORNER ESP","10019-0075-87 - ESMOLOL 2 000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV"]
["UPHAMS CORNER ESP","25021-0826-82 - PR ZOLDERONIC ACID 1MG"]
["UPHAMS CORNER ESP","35573-0443-25 - PR LEVALBUTEROL NON-COMP UNIT"]
["UPHAMS CORNER ESP","43598-0448-74 - HC 250 SHELL"]
["UPHAMS CORNER ESP","49884-0641-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","50268-0366-11 - HC 250 SHELL"]
["UPHAMS CORNER ESP","51079-0197-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","51645-0851-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","55111-0526-01 - PR TACROLIMUS ORAL PER 1 MG"]
["UPHAMS CORNER ESP","60258-0006-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","60687-0178-11 - HC 250 SHELL"]
["UPHAMS CORNER ESP","60687-0661-11 - HC 250 SHELL"]
["UPHAMS CORNER ESP","62756-0059-40 - PR EPOPROSTENOL INJECTION"]
["UPHAMS CORNER ESP","63323-0376-01 - PR OCTREOTIDE INJ, NON-DEPOT"]
["UPHAMS CORNER ESP","63739-0572-10 - HC 250 SHELL"]
["UPHAMS CORNER ESP","67457-0228-10 - HC 250 SHELL"]
["UPHAMS CORNER ESP","68084-0313-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","69238-2078-01 - HC 250 SHELL"]
["UPHAMS CORNER ESP","70069-0013-01 - INJ, GLYCOPYRROLATE, 0.1 MG"]
["UPHAMS CORNER ESP","70954-0151-10 - HC 250 SHELL"]
["UPHAMS CORNER ESP","76204-0200-01 - PR ALBUTEROL NON-COMP UNIT"]
["UPHAMS CORNER ESP","99999-4085-20 - HC 250 SHELL"]
["UPHAMS CORNER ESP","99999-9996-31 - HC 250 SHELL"]
["WELLCARE","00143-9702-01 - PR IRINOTECAN INJECTION"]
["WELLCARE","00409-2587-05 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["WELLCARE","00517-2310-01 - PR IRON SUCROSE INJECTION"]
["WELLCARE","25021-0233-20 - PR OXALIPLATIN"]
["WELLCARE","50242-0070-01 - PR OBINUTUZUMAB INJ"]
["WELLCARE","55513-0112-01 - TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE"]
["WELLCARE","63323-0276-02 - HEPARIN  PORCINE (PF) 1 000 UNIT/ML INJECTION SOLUTION"]
["WELLCARE","67457-0182-00 - PR INJ, ESMOLOL HCL, 10MG"]
["WELLCARE","76075-0101-01 - PR INJECTION, CARFILZOMIB, 1 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00003-2187-13 - PR ABATACEPT INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00049-4910-41 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00093-1172-01 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00121-1882-11 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00143-9875-01 - PR AMIODARONE HCL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00378-7100-77 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00409-1163-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00517-0901-25 - PR HYDRALAZINE HCL INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00536-1327-10 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00641-6027-01 - PR FENTANYL CITRATE INJECITON"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","00904-6620-61 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","01490-0039-04 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","23155-0473-31 - PR FUROSEMIDE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","27241-0211-30 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","37864-0000-52 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","45802-0732-00 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","50242-0040-62 - PR OMALIZUMAB INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","50268-0573-11 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","51672-1258-02 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","52817-0361-10 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","58160-0842-43 - PR TDAP VACCINE >7 YO, IM"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","59676-0310-01 - PR EPOETIN ALFA, NON-ESRD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","60687-0273-21 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","61958-0701-01 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","63323-0117-01 - PR FLUOROURACIL INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","63739-0988-32 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","63833-0518-02 - PR FACTOR XIII ANTI-HEM FACTOR"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","67457-0423-12 - PR DEXAMETHASONE SODIUM PHOS"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","68001-0438-16 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","68382-0529-60 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","70092-1478-44 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","72682-2625-00 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99940-8011-44 - HC 636 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99999-9995-96 - HC 250 SHELL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99999-9997-24 - HC 250 SHELL"]
["WELLSENSE MEDICARE MANAGED","00264-5535-32 - PR INJ, METRONIDAZOLE, 10 MG"]
["WELLSENSE MEDICARE MANAGED","00409-1560-10 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["WELLSENSE MEDICARE MANAGED","00641-6028-25 - PR FENTANYL CITRATE INJECITON"]
["WELLSENSE MEDICARE MANAGED","25021-0461-10 - PR INJ DESMOPRESSIN ACETATE"]
["WELLSENSE MEDICARE MANAGED","50242-0137-01 - PR TOCILIZUMAB INJECTION"]
["WELLSENSE MEDICARE MANAGED","61703-0363-18 - PR OXALIPLATIN"]
["WELLSENSE MEDICARE MANAGED","63323-0965-20 - PR INJ POTASSIUM CHLORIDE"]
["WELLSENSE MEDICARE MANAGED","67457-0351-10 - PR AMPICILLIN 500 MG INJ"]
["WELLSENSE MEDICARE MANAGED","81284-0213-01 - PR INJ PHENYLEPHRINE HCL 20 MCG"]
["WORKERS COMP","00003-0293-20 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WORKERS COMP","00074-7069-11 - HC 250 SHELL"]
["WORKERS COMP","00093-2210-05 - HC 250 SHELL"]
["WORKERS COMP","00131-2477-60 - HC 250 SHELL"]
["WORKERS COMP","00338-0072-25 - PR KETOROLAC TROMETHAMINE INJ"]
["WORKERS COMP","00378-1049-01 - HC 250 SHELL"]
["WORKERS COMP","00409-1560-18 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["WORKERS COMP","00517-2340-10 - PR IRON SUCROSE INJECTION"]
["WORKERS COMP","00555-0159-02 - HC 250 SHELL"]
["WORKERS COMP","00904-5959-61 - HC 250 SHELL"]
["WORKERS COMP","00904-7047-61 - HC 250 SHELL"]
["WORKERS COMP","08290-3064-14 - PR INJ HEPARIN SODIUM PER 10 U"]
["WORKERS COMP","24208-0342-05 - HC 250 SHELL"]
["WORKERS COMP","25021-0410-77 - PR INJ ENOXAPARIN SODIUM"]
["WORKERS COMP","43598-0213-50 - HC 250 SHELL"]
["WORKERS COMP","45963-0438-64 - HC 250 SHELL"]
["WORKERS COMP","50242-0087-01 - PR INJ, ADO-TRASTUZUMAB EMT 1MG"]
["WORKERS COMP","51079-0499-01 - HC 250 SHELL"]
["WORKERS COMP","51079-0991-01 - HC 250 SHELL"]
["WORKERS COMP","53489-0215-01 - HC 250 SHELL"]
["WORKERS COMP","58980-0409-12 - HC 250 SHELL"]
["WORKERS COMP","59762-3140-01 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["WORKERS COMP","60687-0670-01 - HC 250 SHELL"]
["WORKERS COMP","61958-2401-01 - HC 250 SHELL"]
["WORKERS COMP","63323-0162-01 - PR KETOROLAC TROMETHAMINE INJ"]
["WORKERS COMP","63323-0469-01 - PR HALOPERIDOL DECANOATE INJ"]
["WORKERS COMP","65862-0107-01 - HC 250 SHELL"]
["WORKERS COMP","67457-0469-10 - PR OXALIPLATIN"]
["WORKERS COMP","68382-0005-14 - HC 250 SHELL"]
["WORKERS COMP","69374-0559-30 - HC 636 SHELL"]
["WORKERS COMP","70860-0210-51 - PR ZOLDERONIC ACID 1MG"]
["WORKERS COMP","73625-0114-11 - HC 250 SHELL"]
["WORKERS COMP","99990-9944-99 - PR OXYTOCIN INJECTION"]
["WORKERS COMP","99999-9408-02 - HC 250 SHELL"]
["ZZZAETNA","00002-5121-01 - HC 250 SHELL"]
["ZZZAETNA","00054-3117-63 - HC 250 SHELL"]
["ZZZAETNA","00093-5060-01 - HC 250 SHELL"]
["ZZZAETNA","00143-9254-25 - PR DOPAMINE INJECTION"]
["ZZZAETNA","00225-0810-47 - HC 250 SHELL"]
["ZZZAETNA","00378-5813-77 - HC 250 SHELL"]
["ZZZAETNA","00409-2051-15 - HC 250 SHELL"]
["ZZZAETNA","00409-4933-11 - PR ADRENALIN EPINEPHRINE INJECT"]
["ZZZAETNA","00574-7034-12 - HC 250 SHELL"]
["ZZZAETNA","00781-3315-70 - PR OXALIPLATIN"]
["ZZZAETNA","00904-6868-61 - HC 250 SHELL"]
["ZZZAETNA","09999-1289-36 - PR MORPHINE SULFATE INJECTION"]
["ZZZAETNA","13668-0453-01 - HC 250 SHELL"]
["ZZZAETNA","25021-0173-04 - PR AMIKACIN SULFATE INJECTION"]
["ZZZAETNA","42023-0113-10 - HC 250 SHELL"]
["ZZZAETNA","43066-0997-01 - HC 250 SHELL"]
["ZZZAETNA","50268-0102-11 - HC 250 SHELL"]
["ZZZAETNA","50474-0770-09 - HC 250 SHELL"]
["ZZZAETNA","51224-0222-30 - PR AZITHROMYCIN DIHYDRATE, ORAL"]
["ZZZAETNA","54838-0005-30 - HC 250 SHELL"]
["ZZZAETNA","55150-0304-01 - PR DEXAMETHASONE SODIUM PHOS"]
["ZZZAETNA","59572-0711-01 - PR INJ LUSPATERCEPT-AAMT 0.25MG"]
["ZZZAETNA","60687-0423-11 - HC 250 SHELL"]
["ZZZAETNA","60687-0672-65 - HC 250 SHELL"]
["ZZZAETNA","61958-2901-02 - PR INJ, REMDESIVIR, 1 MG"]
["ZZZAETNA","63323-0526-03 - PR ARGATROBAN NONESRD USE 1MG"]
["ZZZAETNA","63739-0795-10 - HC 250 SHELL"]
["ZZZAETNA","67877-0198-05 - HC 250 SHELL"]
["ZZZAETNA","68084-0220-11 - PR ONDANSETRON 1 MG, ORAL"]
["ZZZAETNA","68180-0965-09 - HC 250 SHELL"]
["ZZZAETNA","70700-0186-22 - PR FLUOROURACIL INJECTION"]
["ZZZAETNA","70954-0518-10 - HC 250 SHELL"]
["ZZZAETNA","75834-0159-05 - HC 250 SHELL"]
["ZZZAETNA","99999-9384-88 - HC 250 SHELL"]
["ZZZAETNA","99999-9996-36 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00054-8526-25 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00074-3642-03 - PR LEUPROLIDE ACETATE SUSPNSION"]
["ZZZBU EMPLOYEE WORK COMP","00121-0581-05 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00186-0776-60 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00338-0013-04 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00378-6172-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00409-4031-01 - PR MANNITOL INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","00487-9901-30 - PR ALBUTEROL NON-COMP CON"]
["ZZZBU EMPLOYEE WORK COMP","00781-1874-31 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00904-2085-60 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","00904-6907-06 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","12870-0001-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","23155-0473-31 - PR FUROSEMIDE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","27241-0062-03 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","43598-0262-02 - PR INJECTION, FULVESTRANT"]
["ZZZBU EMPLOYEE WORK COMP","49281-0423-88 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["ZZZBU EMPLOYEE WORK COMP","50474-0770-09 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","51079-0436-20 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","51293-0616-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","55111-0681-11 - PR FONDAPARINUX SODIUM"]
["ZZZBU EMPLOYEE WORK COMP","57896-0629-12 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","60505-0114-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","60687-0758-11 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","62584-0265-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","63323-0692-10 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZBU EMPLOYEE WORK COMP","64281-0113-00 - HC 636 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","65862-0840-03 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","67877-0223-05 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","68180-0159-01 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","69315-0116-10 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","71288-0436-91 - PR INJ ENOXAPARIN SODIUM"]
["ZZZBU EMPLOYEE WORK COMP","76075-0101-01 - PR INJECTION, CARFILZOMIB, 1 MG"]
["ZZZBU EMPLOYEE WORK COMP","87701-0921-72 - HC 250 SHELL"]
["ZZZBU EMPLOYEE WORK COMP","99999-9997-51 - HC 250 SHELL"]
["ZZZCCA ONECARE","00069-0809-01 - PR INJECTION, INFLECTRA"]
["ZZZCCA ONECARE","00310-4535-30 - PR INJ, TREMELIMUMAB-ACTL, 1 MG"]
["ZZZCCA ONECARE","00703-4502-01 - PR METOCLOPRAMIDE HCL INJECTION"]
["ZZZCCA ONECARE","10019-0120-01 - PR INJ, ESMOLOL HCL, 10MG"]
["ZZZCCA ONECARE","50474-0700-62 - CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT"]
["ZZZCCA ONECARE","55513-0025-04 - PR DARBEPOETIN ALFA, NON-ESRD"]
["ZZZCCA ONECARE","61703-0339-22 - PR CARBOPLATIN INJECTION"]
["ZZZCCA ONECARE","67457-0617-30 - PR GEMCITABINE HCL"]
["ZZZCCA ONECARE","70860-0406-10 - INJ, BUMETANIDE, 0.5 MG"]
["ZZZCIGNA","00013-5301-17 - HC 250 SHELL"]
["ZZZCIGNA","00054-3185-44 - HC 250 SHELL"]
["ZZZCIGNA","00074-7069-11 - HC 250 SHELL"]
["ZZZCIGNA","00143-9086-01 - PR DOXORUBIC HCL 10 MG VL CHEMO"]
["ZZZCIGNA","00225-0525-47 - HC 250 SHELL"]
["ZZZCIGNA","00338-0067-01 - PR DOXORUBICIN INJ 10MG"]
["ZZZCIGNA","00409-3724-11 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCIGNA","00409-9042-16 - HC 250 SHELL"]
["ZZZCIGNA","00603-1542-15 - HC 250 SHELL"]
["ZZZCIGNA","00641-6060-01 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["ZZZCIGNA","00904-5790-61 - PR ORAL PRESCRIP DRUG NON CHEMO"]
["ZZZCIGNA","09994-0900-55 - HC 250 SHELL"]
["ZZZCIGNA","16729-0225-16 - HC 250 SHELL"]
["ZZZCIGNA","29300-0168-15 - HC 250 SHELL"]
["ZZZCIGNA","42571-0162-01 - HC 250 SHELL"]
["ZZZCIGNA","43598-0561-78 - HC 250 SHELL"]
["ZZZCIGNA","50268-0069-11 - HC 250 SHELL"]
["ZZZCIGNA","50268-0523-15 - HC 250 SHELL"]
["ZZZCIGNA","51079-0455-01 - HC 250 SHELL"]
["ZZZCIGNA","54288-0167-01 - PR CARBOPLATIN INJECTION"]
["ZZZCIGNA","55513-0141-01 - PR INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG"]
["ZZZCIGNA","60219-1749-03 - HC 250 SHELL"]
["ZZZCIGNA","60505-2528-06 - HC 250 SHELL"]
["ZZZCIGNA","60793-0700-10 - PR PENICILLIN G BENZATHINE INJ"]
["ZZZCIGNA","61958-1501-01 - HC 250 SHELL"]
["ZZZCIGNA","63323-0286-11 - PR ROPIVACAINE HCL INJECTION"]
["ZZZCIGNA","64950-0362-04 - COCAINE 4 % NASAL SOLUTION"]
["ZZZCIGNA","66302-0664-01 - HC 250 SHELL"]
["ZZZCIGNA","68084-0536-11 - HC 250 SHELL"]
["ZZZCIGNA","69097-0516-07 - PR CYCLOPHOSPHAMIDE ORAL 25 MG"]
["ZZZCIGNA","69374-0529-30 - HC 636 SHELL"]
["ZZZCIGNA","71351-0013-99 - HC 250 SHELL"]
["ZZZCIGNA","73535-0208-01 - TAFASITAMAB-CXIX 200 MG/5 ML IV (RECONSTITUTED VIAL)"]
["ZZZCIGNA","99999-9995-07 - HC 250 SHELL"]
["ZZZCIGNA","99999-9998-12 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00016-0316-60 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00078-0696-20 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00093-4175-73 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00143-9335-01 - PR INJ, BUPIVACAINE, NOS, 0.5MG"]
["ZZZCITY OF BOSTON WORK COMP","00338-0357-03 - PR MANNITOL INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","00378-4105-91 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00436-0672-16 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00555-0159-02 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00603-1542-58 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00904-6322-61 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","00904-6828-94 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","08627-0078-01 - HC PHARMACY NON FORMULARY CHARGE FOR REVIEW"]
["ZZZCITY OF BOSTON WORK COMP","24338-0230-05 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","31722-0631-31 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","44567-0400-10 - PR MEROPENEM"]
["ZZZCITY OF BOSTON WORK COMP","48433-0108-01 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","50268-0086-11 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","51079-0632-01 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","51079-0991-20 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","55513-0006-01 - PR DARBEPOETIN ALFA, NON-ESRD"]
["ZZZCITY OF BOSTON WORK COMP","59390-0190-50 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","60505-6128-00 - PR IRINOTECAN INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","61314-0326-10 - PR INJECTION, ZARXIO"]
["ZZZCITY OF BOSTON WORK COMP","62332-0385-30 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","63323-0276-02 - HEPARIN  PORCINE (PF) 1 000 UNIT/ML INJECTION SOLUTION"]
["ZZZCITY OF BOSTON WORK COMP","65162-0442-10 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","66993-0068-51 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","68084-0220-11 - PR ONDANSETRON 1 MG, ORAL"]
["ZZZCITY OF BOSTON WORK COMP","68455-0106-90 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","69547-0353-02 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","70515-0262-10 - PR DIGOXIN INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","73625-0111-11 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","99994-0875-54 - HC 250 SHELL"]
["ZZZCITY OF BOSTON WORK COMP","99999-9999-54 - HC 250 SHELL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","00121-0978-10 - PR DIPHENHYDRAMINE HCL 50MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","00409-1985-30 - PR LORAZEPAM INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","00703-3218-01 - PR PACLITAXEL INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","23155-0473-32 - PR FUROSEMIDE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","42023-0168-01 - PR ADRENALIN EPINEPHRINE INJECT"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","57894-0160-01 - PR INFLIXIMAB INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","63323-0412-13 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","68084-0450-11 - PR TACROLIMUS ORAL PER 1 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","71546-0080-05 - PR SUCCINYCHOLINE CHLORIDE INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","99999-9342-70 - PR INJ MIDAZOLAM HYDROCHLORIDE"]
["ZZZHEALTH PLANS INC","00143-9398-01 - PR ERTAPENEM INJECTION"]
["ZZZHEALTH PLANS INC","00409-4520-02 - PR INJ HEPARIN SODIUM PER 1000U"]
["ZZZHEALTH PLANS INC","00517-0720-01 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZHEALTH PLANS INC","25021-0806-01 - PR HALOPERIDOL INJECTION"]
["ZZZHEALTH PLANS INC","49401-0088-01 - PR BELIMUMAB INJECTION"]
["ZZZHEALTH PLANS INC","59572-0102-01 - PR AZACITIDINE INJECTION"]
["ZZZHEALTH PLANS INC","63323-0104-25 - PR ETOPOSIDE 10 MG INJ"]
["ZZZHEALTH PLANS INC","63323-0526-03 - PR ARGATROBAN NONESRD USE 1MG"]
["ZZZHEALTH PLANS INC","68001-0525-27 - PR FLUOROURACIL INJECTION"]
["ZZZHEALTH PLANS INC","76329-3318-01 - PR ADRENALIN EPINEPHRINE INJECT"]
["ZZZRAILROAD MEDICARE","00003-0293-05 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZRAILROAD MEDICARE","00409-4755-18 - PR ONDANSETRON HCL INJECTION"]
["ZZZRAILROAD MEDICARE","00641-1495-35 - PR PROMETHAZINE HCL INJECTION"]
["ZZZRAILROAD MEDICARE","25021-0461-10 - PR INJ DESMOPRESSIN ACETATE"]
["ZZZRAILROAD MEDICARE","50242-0138-01 - PR TOCILIZUMAB INJECTION"]
["ZZZRAILROAD MEDICARE","55150-0273-01 - PR THIAMINE HCL 100 MG"]
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["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 19120 - PR EXCISE BREAST CYST","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 66821 - PR DISCISSION,2ND CATARACT,LASER","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72148 - CHG MRI, LUMBAR SPINE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80055 - CHG OBSTETRIC PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80061 - CHG LIPID PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80069 - CHG RENAL FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80076 - CHG HEPATIC FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 84443 - CHG ASSAY THYROID STIM HORMONE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85027 - CHG COMPLETE CBC","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90715 - PR TDAP VACCINE >7 YO, IM","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90853 - PR GROUP PSYCHOTHERAPY","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 97110 - PR THERAPEUTIC EXERCISES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9500 - PR TC99M SESTAMIBI","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9513 - DELETED 2077","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9517 - PR I131 IODIDE CAP, RX","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9552 - PR F18 FDG","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9555 - PR RB82 RUBIDIUM","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9581 - PR GADOXETATE DISODIUM INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 19120 - PR EXCISE BREAST CYST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 66821 - PR DISCISSION,2ND CATARACT,LASER","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72148 - CHG MRI, LUMBAR SPINE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80055 - CHG OBSTETRIC PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80061 - CHG LIPID PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80069 - CHG RENAL FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80076 - CHG HEPATIC FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 84443 - CHG ASSAY THYROID STIM HORMONE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85027 - CHG COMPLETE CBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90715 - PR TDAP VACCINE >7 YO, IM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90853 - PR GROUP PSYCHOTHERAPY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 97110 - PR THERAPEUTIC EXERCISES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9500 - PR TC99M SESTAMIBI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9513 - DELETED 2077","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9517 - PR I131 IODIDE CAP, RX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9552 - PR F18 FDG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9555 - PR RB82 RUBIDIUM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9581 - PR GADOXETATE DISODIUM INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 19120 - PR EXCISE BREAST CYST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 66821 - PR DISCISSION,2ND CATARACT,LASER","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72148 - CHG MRI, LUMBAR SPINE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80055 - CHG OBSTETRIC PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80061 - CHG LIPID PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80069 - CHG RENAL FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80076 - CHG HEPATIC FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 84443 - CHG ASSAY THYROID STIM HORMONE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85027 - CHG COMPLETE CBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90715 - PR TDAP VACCINE >7 YO, IM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90853 - PR GROUP PSYCHOTHERAPY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 97110 - PR THERAPEUTIC EXERCISES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9500 - PR TC99M SESTAMIBI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9513 - DELETED 2077","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9517 - PR I131 IODIDE CAP, RX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9552 - PR F18 FDG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9555 - PR RB82 RUBIDIUM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9581 - PR GADOXETATE DISODIUM INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 19120 - PR EXCISE BREAST CYST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 66821 - PR DISCISSION,2ND CATARACT,LASER","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72148 - CHG MRI, LUMBAR SPINE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80055 - CHG OBSTETRIC PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80061 - CHG LIPID PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80069 - CHG RENAL FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80076 - CHG HEPATIC FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 84443 - CHG ASSAY THYROID STIM HORMONE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85027 - CHG COMPLETE CBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90715 - PR TDAP VACCINE >7 YO, IM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90853 - PR GROUP PSYCHOTHERAPY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 97110 - PR THERAPEUTIC EXERCISES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9500 - PR TC99M SESTAMIBI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9513 - DELETED 2077","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9517 - PR I131 IODIDE CAP, RX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9552 - PR F18 FDG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9555 - PR RB82 RUBIDIUM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9581 - PR GADOXETATE DISODIUM INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA HMO - CPT - 19120","AETNA - AETNA HMO - 19120","AETNA - AETNA HMO - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA HMO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA HMO - CPT - 29881","AETNA - AETNA HMO - 29881","AETNA - AETNA HMO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA HMO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA HMO - CPT - 43235","AETNA - AETNA HMO - 43235","AETNA - AETNA HMO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA HMO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA HMO - CPT - 43239","AETNA - AETNA HMO - 43239","AETNA - AETNA HMO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA HMO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA HMO - CPT - 45378","AETNA - AETNA HMO - 45378","AETNA - AETNA HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA HMO - CPT - 45378","AETNA - AETNA HMO - 45378","AETNA - AETNA HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA HMO - CPT - 45378","AETNA - AETNA HMO - 45378","AETNA - AETNA HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA HMO - CPT - 45380","AETNA - AETNA HMO - 45380","AETNA - AETNA HMO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA HMO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA HMO - CPT - 45385","AETNA - AETNA HMO - 45385","AETNA - AETNA HMO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA HMO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA HMO - CPT - 45391","AETNA - AETNA HMO - 45391","AETNA - AETNA HMO - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA HMO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA HMO - CPT - 55700","AETNA - AETNA HMO - 55700","AETNA - AETNA HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA HMO - CPT - 55700","AETNA - AETNA HMO - 55700","AETNA - AETNA HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA HMO - CPT - 62322","AETNA - AETNA HMO - 62322","AETNA - AETNA HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA HMO - CPT - 62322","AETNA - AETNA HMO - 62322","AETNA - AETNA HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA HMO - CPT - 62323","AETNA - AETNA HMO - 62323","AETNA - AETNA HMO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA HMO - CPT - 64483","AETNA - AETNA HMO - 64483","AETNA - AETNA HMO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA HMO - CPT - 66821","AETNA - AETNA HMO - 66821","AETNA - AETNA HMO - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA HMO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA HMO - CPT - 66984","AETNA - AETNA HMO - 66984","AETNA - AETNA HMO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA HMO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA HMO - CPT - 70450","AETNA - AETNA HMO - 70450","AETNA - AETNA HMO - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA HMO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA HMO - CPT - 70553","AETNA - AETNA HMO - 70553","AETNA - AETNA HMO - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA HMO - CPT - 70553","AETNA - AETNA HMO - 70553","AETNA - AETNA HMO - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA HMO - CPT - 72110","AETNA - AETNA HMO - 72110","AETNA - AETNA HMO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA HMO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA HMO - CPT - 72148","AETNA - AETNA HMO - 72148","AETNA - AETNA HMO - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA HMO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA HMO - CPT - 72193","AETNA - AETNA HMO - 72193","AETNA - AETNA HMO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA HMO - CPT - 73721","AETNA - AETNA HMO - 73721","AETNA - AETNA HMO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA HMO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA HMO - CPT - 74177","AETNA - AETNA HMO - 74177","AETNA - AETNA HMO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA HMO - CPT - 76700","AETNA - AETNA HMO - 76700","AETNA - AETNA HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA HMO - CPT - 76700","AETNA - AETNA HMO - 76700","AETNA - AETNA HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA HMO - CPT - 76805","AETNA - AETNA HMO - 76805","AETNA - AETNA HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA HMO - CPT - 76805","AETNA - AETNA HMO - 76805","AETNA - AETNA HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA HMO - CPT - 76830","AETNA - AETNA HMO - 76830","AETNA - AETNA HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA HMO - CPT - 76830","AETNA - AETNA HMO - 76830","AETNA - AETNA HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA HMO - CPT - 77065","AETNA - AETNA HMO - 77065","AETNA - AETNA HMO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA HMO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA HMO - CPT - 77066","AETNA - AETNA HMO - 77066","AETNA - AETNA HMO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA HMO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA HMO - CPT - 77067","AETNA - AETNA HMO - 77067","AETNA - AETNA HMO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA HMO - CPT - 80048","AETNA - AETNA HMO - 80048","AETNA - AETNA HMO - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA HMO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA HMO - CPT - 80053","AETNA - AETNA HMO - 80053","AETNA - AETNA HMO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA HMO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA HMO - CPT - 80055","AETNA - AETNA HMO - 80055","AETNA - AETNA HMO - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA HMO - CPT - 80061","AETNA - AETNA HMO - 80061","AETNA - AETNA HMO - 80061 - CHG LIPID PANEL","AETNA","AETNA HMO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA HMO - CPT - 80069","AETNA - AETNA HMO - 80069","AETNA - AETNA HMO - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA HMO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA HMO - CPT - 80076","AETNA - AETNA HMO - 80076","AETNA - AETNA HMO - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA HMO - CPT - 81000","AETNA - AETNA HMO - 81000","AETNA - AETNA HMO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA HMO - CPT - 81000","AETNA - AETNA HMO - 81000","AETNA - AETNA HMO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA HMO - CPT - 81001","AETNA - AETNA HMO - 81001","AETNA - AETNA HMO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA HMO - CPT - 81002","AETNA - AETNA HMO - 81002","AETNA - AETNA HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA HMO - CPT - 81002","AETNA - AETNA HMO - 81002","AETNA - AETNA HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA HMO - CPT - 81003","AETNA - AETNA HMO - 81003","AETNA - AETNA HMO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA HMO - CPT - 81003","AETNA - AETNA HMO - 81003","AETNA - AETNA HMO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA HMO - CPT - 84153","AETNA - AETNA HMO - 84153","AETNA - AETNA HMO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA HMO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA HMO - CPT - 84443","AETNA - AETNA HMO - 84443","AETNA - AETNA HMO - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA HMO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA HMO - CPT - 85025","AETNA - AETNA HMO - 85025","AETNA - AETNA HMO - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA HMO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA HMO - CPT - 85027","AETNA - AETNA HMO - 85027","AETNA - AETNA HMO - 85027 - CHG COMPLETE CBC","AETNA","AETNA HMO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA HMO - CPT - 85610","AETNA - AETNA HMO - 85610","AETNA - AETNA HMO - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA HMO - CPT - 85610","AETNA - AETNA HMO - 85610","AETNA - AETNA HMO - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA HMO - CPT - 85730","AETNA - AETNA HMO - 85730","AETNA - AETNA HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA HMO - CPT - 85730","AETNA - AETNA HMO - 85730","AETNA - AETNA HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA HMO - CPT - 90662","AETNA - AETNA HMO - 90662","AETNA - AETNA HMO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA HMO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA HMO - CPT - 90686","AETNA - AETNA HMO - 90686","AETNA - AETNA HMO - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA HMO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA HMO - CPT - 90715","AETNA - AETNA HMO - 90715","AETNA - AETNA HMO - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA HMO - CPT - 90832","AETNA - AETNA HMO - 90832","AETNA - AETNA HMO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA HMO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA HMO - CPT - 90834","AETNA - AETNA HMO - 90834","AETNA - AETNA HMO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA HMO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA HMO - CPT - 90837","AETNA - AETNA HMO - 90837","AETNA - AETNA HMO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA HMO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA HMO - CPT - 90846","AETNA - AETNA HMO - 90846","AETNA - AETNA HMO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA HMO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA HMO - CPT - 90847","AETNA - AETNA HMO - 90847","AETNA - AETNA HMO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA HMO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA HMO - CPT - 90853","AETNA - AETNA HMO - 90853","AETNA - AETNA HMO - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA HMO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA HMO - CPT - 93452","AETNA - AETNA HMO - 93452","AETNA - AETNA HMO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA HMO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA HMO - CPT - 95810","AETNA - AETNA HMO - 95810","AETNA - AETNA HMO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA HMO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA HMO - CPT - 97110","AETNA - AETNA HMO - 97110","AETNA - AETNA HMO - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA HMO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA HMO - CPT - 99203","AETNA - AETNA HMO - 99203","AETNA - AETNA HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA HMO - CPT - 99203","AETNA - AETNA HMO - 99203","AETNA - AETNA HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA HMO - CPT - 99204","AETNA - AETNA HMO - 99204","AETNA - AETNA HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA HMO - CPT - 99204","AETNA - AETNA HMO - 99204","AETNA - AETNA HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA HMO - CPT - 99205","AETNA - AETNA HMO - 99205","AETNA - AETNA HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA HMO - CPT - 99205","AETNA - AETNA HMO - 99205","AETNA - AETNA HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA HMO - CPT - 99212","AETNA - AETNA HMO - 99212","AETNA - AETNA HMO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA HMO - CPT - 99212","AETNA - AETNA HMO - 99212","AETNA - AETNA HMO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA HMO - CPT - 99213","AETNA - AETNA HMO - 99213","AETNA - AETNA HMO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA HMO - CPT - 99213","AETNA - AETNA HMO - 99213","AETNA - AETNA HMO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA HMO - CPT - 99214","AETNA - AETNA HMO - 99214","AETNA - AETNA HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA HMO - CPT - 99214","AETNA - AETNA HMO - 99214","AETNA - AETNA HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA HMO - CPT - 99215","AETNA - AETNA HMO - 99215","AETNA - AETNA HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA HMO - CPT - 99215","AETNA - AETNA HMO - 99215","AETNA - AETNA HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA HMO - CPT - 99385","AETNA - AETNA HMO - 99385","AETNA - AETNA HMO - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA HMO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA HMO - CPT - 99386","AETNA - AETNA HMO - 99386","AETNA - AETNA HMO - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA HMO","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA HMO - CPT - A9500","AETNA - AETNA HMO - A9500","AETNA - AETNA HMO - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA HMO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AETNA - AETNA HMO - CPT - A9513","AETNA - AETNA HMO - A9513","AETNA - AETNA HMO - A9513 - DELETED 2077","AETNA","AETNA HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25]
["AETNA - AETNA HMO - CPT - A9517","AETNA - AETNA HMO - A9517","AETNA - AETNA HMO - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA HMO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA HMO - CPT - A9552","AETNA - AETNA HMO - A9552","AETNA - AETNA HMO - A9552 - PR F18 FDG","AETNA","AETNA HMO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AETNA - AETNA HMO - CPT - A9555","AETNA - AETNA HMO - A9555","AETNA - AETNA HMO - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA HMO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AETNA - AETNA HMO - CPT - A9575","AETNA - AETNA HMO - A9575","AETNA - AETNA HMO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA HMO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AETNA - AETNA HMO - CPT - A9579","AETNA - AETNA HMO - A9579","AETNA - AETNA HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["AETNA - AETNA HMO - CPT - A9579","AETNA - AETNA HMO - A9579","AETNA - AETNA HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["AETNA - AETNA HMO - CPT - A9581","AETNA - AETNA HMO - A9581","AETNA - AETNA HMO - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA HMO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AETNA - AETNA HMO - CPT - J1030","AETNA - AETNA HMO - J1030","AETNA - AETNA HMO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA HMO - CPT - J3301","AETNA - AETNA HMO - J3301","AETNA - AETNA HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA HMO - CPT - P9047","AETNA - AETNA HMO - P9047","AETNA - AETNA HMO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA HMO - CPT - Q9958","AETNA - AETNA HMO - Q9958","AETNA - AETNA HMO - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA HMO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9963","AETNA - AETNA HMO - Q9963","AETNA - AETNA HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9963","AETNA - AETNA HMO - Q9963","AETNA - AETNA HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9966","AETNA - AETNA HMO - Q9966","AETNA - AETNA HMO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - 19120","AETNA - AETNA MCR SUPP - 19120","AETNA - AETNA MCR SUPP - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA MCR SUPP","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA MCR SUPP - CPT - 29881","AETNA - AETNA MCR SUPP - 29881","AETNA - AETNA MCR SUPP - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA MCR SUPP","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA MCR SUPP - CPT - 43235","AETNA - AETNA MCR SUPP - 43235","AETNA - AETNA MCR SUPP - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA MCR SUPP","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA MCR SUPP - CPT - 43239","AETNA - AETNA MCR SUPP - 43239","AETNA - AETNA MCR SUPP - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA MCR SUPP","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA - AETNA MCR SUPP - 45378","AETNA - AETNA MCR SUPP - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA - AETNA MCR SUPP - 45378","AETNA - AETNA MCR SUPP - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA - AETNA MCR SUPP - 45378","AETNA - AETNA MCR SUPP - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA MCR SUPP - CPT - 45380","AETNA - AETNA MCR SUPP - 45380","AETNA - AETNA MCR SUPP - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA MCR SUPP","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA MCR SUPP - CPT - 45385","AETNA - AETNA MCR SUPP - 45385","AETNA - AETNA MCR SUPP - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA MCR SUPP","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA MCR SUPP - CPT - 45391","AETNA - AETNA MCR SUPP - 45391","AETNA - AETNA MCR SUPP - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA MCR SUPP","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA MCR SUPP - CPT - 55700","AETNA - AETNA MCR SUPP - 55700","AETNA - AETNA MCR SUPP - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA MCR SUPP","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA MCR SUPP - CPT - 55700","AETNA - AETNA MCR SUPP - 55700","AETNA - AETNA MCR SUPP - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA MCR SUPP","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA MCR SUPP - CPT - 62322","AETNA - AETNA MCR SUPP - 62322","AETNA - AETNA MCR SUPP - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA MCR SUPP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA MCR SUPP - CPT - 62322","AETNA - AETNA MCR SUPP - 62322","AETNA - AETNA MCR SUPP - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA MCR SUPP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA MCR SUPP - CPT - 62323","AETNA - AETNA MCR SUPP - 62323","AETNA - AETNA MCR SUPP - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA MCR SUPP","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA MCR SUPP - CPT - 64483","AETNA - AETNA MCR SUPP - 64483","AETNA - AETNA MCR SUPP - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA MCR SUPP","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA MCR SUPP - CPT - 66821","AETNA - AETNA MCR SUPP - 66821","AETNA - AETNA MCR SUPP - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA MCR SUPP","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA MCR SUPP - CPT - 66984","AETNA - AETNA MCR SUPP - 66984","AETNA - AETNA MCR SUPP - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA MCR SUPP","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA MCR SUPP - CPT - 70450","AETNA - AETNA MCR SUPP - 70450","AETNA - AETNA MCR SUPP - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA MCR SUPP","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA MCR SUPP - CPT - 70553","AETNA - AETNA MCR SUPP - 70553","AETNA - AETNA MCR SUPP - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA MCR SUPP","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA MCR SUPP - CPT - 70553","AETNA - AETNA MCR SUPP - 70553","AETNA - AETNA MCR SUPP - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA MCR SUPP","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA MCR SUPP - CPT - 72110","AETNA - AETNA MCR SUPP - 72110","AETNA - AETNA MCR SUPP - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA MCR SUPP","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA MCR SUPP - CPT - 72148","AETNA - AETNA MCR SUPP - 72148","AETNA - AETNA MCR SUPP - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA MCR SUPP","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA MCR SUPP - CPT - 72193","AETNA - AETNA MCR SUPP - 72193","AETNA - AETNA MCR SUPP - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA MCR SUPP","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA MCR SUPP - CPT - 73721","AETNA - AETNA MCR SUPP - 73721","AETNA - AETNA MCR SUPP - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA MCR SUPP","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA MCR SUPP - CPT - 74177","AETNA - AETNA MCR SUPP - 74177","AETNA - AETNA MCR SUPP - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA MCR SUPP","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA MCR SUPP - CPT - 76700","AETNA - AETNA MCR SUPP - 76700","AETNA - AETNA MCR SUPP - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA MCR SUPP","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA MCR SUPP - CPT - 76700","AETNA - AETNA MCR SUPP - 76700","AETNA - AETNA MCR SUPP - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA MCR SUPP","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA MCR SUPP - CPT - 76805","AETNA - AETNA MCR SUPP - 76805","AETNA - AETNA MCR SUPP - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA MCR SUPP","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA MCR SUPP - CPT - 76805","AETNA - AETNA MCR SUPP - 76805","AETNA - AETNA MCR SUPP - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA MCR SUPP","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA MCR SUPP - CPT - 76830","AETNA - AETNA MCR SUPP - 76830","AETNA - AETNA MCR SUPP - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA MCR SUPP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA MCR SUPP - CPT - 76830","AETNA - AETNA MCR SUPP - 76830","AETNA - AETNA MCR SUPP - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA MCR SUPP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA MCR SUPP - CPT - 77065","AETNA - AETNA MCR SUPP - 77065","AETNA - AETNA MCR SUPP - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA MCR SUPP","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA MCR SUPP - CPT - 77066","AETNA - AETNA MCR SUPP - 77066","AETNA - AETNA MCR SUPP - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA MCR SUPP","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA MCR SUPP - CPT - 77067","AETNA - AETNA MCR SUPP - 77067","AETNA - AETNA MCR SUPP - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA MCR SUPP","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA MCR SUPP - CPT - 80048","AETNA - AETNA MCR SUPP - 80048","AETNA - AETNA MCR SUPP - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA MCR SUPP","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA MCR SUPP - CPT - 80053","AETNA - AETNA MCR SUPP - 80053","AETNA - AETNA MCR SUPP - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA MCR SUPP","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA MCR SUPP - CPT - 80055","AETNA - AETNA MCR SUPP - 80055","AETNA - AETNA MCR SUPP - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA MCR SUPP","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA MCR SUPP - CPT - 80061","AETNA - AETNA MCR SUPP - 80061","AETNA - AETNA MCR SUPP - 80061 - CHG LIPID PANEL","AETNA","AETNA MCR SUPP","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA MCR SUPP - CPT - 80069","AETNA - AETNA MCR SUPP - 80069","AETNA - AETNA MCR SUPP - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA MCR SUPP","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA MCR SUPP - CPT - 80076","AETNA - AETNA MCR SUPP - 80076","AETNA - AETNA MCR SUPP - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA MCR SUPP","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA MCR SUPP - CPT - 81000","AETNA - AETNA MCR SUPP - 81000","AETNA - AETNA MCR SUPP - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA MCR SUPP","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA MCR SUPP - CPT - 81000","AETNA - AETNA MCR SUPP - 81000","AETNA - AETNA MCR SUPP - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA MCR SUPP","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA MCR SUPP - CPT - 81001","AETNA - AETNA MCR SUPP - 81001","AETNA - AETNA MCR SUPP - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA MCR SUPP","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA MCR SUPP - CPT - 81002","AETNA - AETNA MCR SUPP - 81002","AETNA - AETNA MCR SUPP - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA MCR SUPP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA MCR SUPP - CPT - 81002","AETNA - AETNA MCR SUPP - 81002","AETNA - AETNA MCR SUPP - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA MCR SUPP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA MCR SUPP - CPT - 81003","AETNA - AETNA MCR SUPP - 81003","AETNA - AETNA MCR SUPP - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA MCR SUPP","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA MCR SUPP - CPT - 81003","AETNA - AETNA MCR SUPP - 81003","AETNA - AETNA MCR SUPP - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA MCR SUPP","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA MCR SUPP - CPT - 84153","AETNA - AETNA MCR SUPP - 84153","AETNA - AETNA MCR SUPP - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA MCR SUPP","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA MCR SUPP - CPT - 84443","AETNA - AETNA MCR SUPP - 84443","AETNA - AETNA MCR SUPP - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA MCR SUPP","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA MCR SUPP - CPT - 85025","AETNA - AETNA MCR SUPP - 85025","AETNA - AETNA MCR SUPP - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA MCR SUPP","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA MCR SUPP - CPT - 85027","AETNA - AETNA MCR SUPP - 85027","AETNA - AETNA MCR SUPP - 85027 - CHG COMPLETE CBC","AETNA","AETNA MCR SUPP","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA MCR SUPP - CPT - 85610","AETNA - AETNA MCR SUPP - 85610","AETNA - AETNA MCR SUPP - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA MCR SUPP","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA MCR SUPP - CPT - 85610","AETNA - AETNA MCR SUPP - 85610","AETNA - AETNA MCR SUPP - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA MCR SUPP","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA MCR SUPP - CPT - 85730","AETNA - AETNA MCR SUPP - 85730","AETNA - AETNA MCR SUPP - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA MCR SUPP","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA MCR SUPP - CPT - 85730","AETNA - AETNA MCR SUPP - 85730","AETNA - AETNA MCR SUPP - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA MCR SUPP","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA MCR SUPP - CPT - 90662","AETNA - AETNA MCR SUPP - 90662","AETNA - AETNA MCR SUPP - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA MCR SUPP","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA MCR SUPP - CPT - 90686","AETNA - AETNA MCR SUPP - 90686","AETNA - AETNA MCR SUPP - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA MCR SUPP","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA MCR SUPP - CPT - 90715","AETNA - AETNA MCR SUPP - 90715","AETNA - AETNA MCR SUPP - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA MCR SUPP","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA MCR SUPP - CPT - 90832","AETNA - AETNA MCR SUPP - 90832","AETNA - AETNA MCR SUPP - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA MCR SUPP","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA MCR SUPP - CPT - 90834","AETNA - AETNA MCR SUPP - 90834","AETNA - AETNA MCR SUPP - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA MCR SUPP","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA MCR SUPP - CPT - 90837","AETNA - AETNA MCR SUPP - 90837","AETNA - AETNA MCR SUPP - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA MCR SUPP","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA MCR SUPP - CPT - 90846","AETNA - AETNA MCR SUPP - 90846","AETNA - AETNA MCR SUPP - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA MCR SUPP","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA MCR SUPP - CPT - 90847","AETNA - AETNA MCR SUPP - 90847","AETNA - AETNA MCR SUPP - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA MCR SUPP","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA MCR SUPP - CPT - 90853","AETNA - AETNA MCR SUPP - 90853","AETNA - AETNA MCR SUPP - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA MCR SUPP","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA MCR SUPP - CPT - 93452","AETNA - AETNA MCR SUPP - 93452","AETNA - AETNA MCR SUPP - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA MCR SUPP","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA MCR SUPP - CPT - 95810","AETNA - AETNA MCR SUPP - 95810","AETNA - AETNA MCR SUPP - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA MCR SUPP","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA MCR SUPP - CPT - 97110","AETNA - AETNA MCR SUPP - 97110","AETNA - AETNA MCR SUPP - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA MCR SUPP","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA MCR SUPP - CPT - 99203","AETNA - AETNA MCR SUPP - 99203","AETNA - AETNA MCR SUPP - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA MCR SUPP","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA MCR SUPP - CPT - 99203","AETNA - AETNA MCR SUPP - 99203","AETNA - AETNA MCR SUPP - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA MCR SUPP","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA MCR SUPP - CPT - 99204","AETNA - AETNA MCR SUPP - 99204","AETNA - AETNA MCR SUPP - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA MCR SUPP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA MCR SUPP - CPT - 99204","AETNA - AETNA MCR SUPP - 99204","AETNA - AETNA MCR SUPP - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA MCR SUPP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA MCR SUPP - CPT - 99205","AETNA - AETNA MCR SUPP - 99205","AETNA - AETNA MCR SUPP - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA MCR SUPP","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA MCR SUPP - CPT - 99205","AETNA - AETNA MCR SUPP - 99205","AETNA - AETNA MCR SUPP - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA MCR SUPP","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA MCR SUPP - CPT - 99212","AETNA - AETNA MCR SUPP - 99212","AETNA - AETNA MCR SUPP - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA MCR SUPP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA MCR SUPP - CPT - 99212","AETNA - AETNA MCR SUPP - 99212","AETNA - AETNA MCR SUPP - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA MCR SUPP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA MCR SUPP - CPT - 99213","AETNA - AETNA MCR SUPP - 99213","AETNA - AETNA MCR SUPP - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA MCR SUPP","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA MCR SUPP - CPT - 99213","AETNA - AETNA MCR SUPP - 99213","AETNA - AETNA MCR SUPP - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA MCR SUPP","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA MCR SUPP - CPT - 99214","AETNA - AETNA MCR SUPP - 99214","AETNA - AETNA MCR SUPP - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA MCR SUPP","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA MCR SUPP - CPT - 99214","AETNA - AETNA MCR SUPP - 99214","AETNA - AETNA MCR SUPP - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA MCR SUPP","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA MCR SUPP - CPT - 99215","AETNA - AETNA MCR SUPP - 99215","AETNA - AETNA MCR SUPP - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA MCR SUPP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA MCR SUPP - CPT - 99215","AETNA - AETNA MCR SUPP - 99215","AETNA - AETNA MCR SUPP - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA MCR SUPP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA MCR SUPP - CPT - 99385","AETNA - AETNA MCR SUPP - 99385","AETNA - AETNA MCR SUPP - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA MCR SUPP","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA MCR SUPP - CPT - 99386","AETNA - AETNA MCR SUPP - 99386","AETNA - AETNA MCR SUPP - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA MCR SUPP","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA MCR SUPP - CPT - A9500","AETNA - AETNA MCR SUPP - A9500","AETNA - AETNA MCR SUPP - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA MCR SUPP","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AETNA - AETNA MCR SUPP - CPT - A9513","AETNA - AETNA MCR SUPP - A9513","AETNA - AETNA MCR SUPP - A9513 - DELETED 2077","AETNA","AETNA MCR SUPP","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25]
["AETNA - AETNA MCR SUPP - CPT - A9517","AETNA - AETNA MCR SUPP - A9517","AETNA - AETNA MCR SUPP - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA MCR SUPP","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA MCR SUPP - CPT - A9552","AETNA - AETNA MCR SUPP - A9552","AETNA - AETNA MCR SUPP - A9552 - PR F18 FDG","AETNA","AETNA MCR SUPP","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AETNA - AETNA MCR SUPP - CPT - A9555","AETNA - AETNA MCR SUPP - A9555","AETNA - AETNA MCR SUPP - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA MCR SUPP","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AETNA - AETNA MCR SUPP - CPT - A9575","AETNA - AETNA MCR SUPP - A9575","AETNA - AETNA MCR SUPP - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA MCR SUPP","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AETNA - AETNA MCR SUPP - CPT - A9579","AETNA - AETNA MCR SUPP - A9579","AETNA - AETNA MCR SUPP - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA MCR SUPP","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["AETNA - AETNA MCR SUPP - CPT - A9579","AETNA - AETNA MCR SUPP - A9579","AETNA - AETNA MCR SUPP - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA MCR SUPP","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["AETNA - AETNA MCR SUPP - CPT - A9581","AETNA - AETNA MCR SUPP - A9581","AETNA - AETNA MCR SUPP - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA MCR SUPP","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AETNA - AETNA MCR SUPP - CPT - J1030","AETNA - AETNA MCR SUPP - J1030","AETNA - AETNA MCR SUPP - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA MCR SUPP","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA MCR SUPP - CPT - J3301","AETNA - AETNA MCR SUPP - J3301","AETNA - AETNA MCR SUPP - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA MCR SUPP","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA MCR SUPP - CPT - P9047","AETNA - AETNA MCR SUPP - P9047","AETNA - AETNA MCR SUPP - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA MCR SUPP","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA MCR SUPP - CPT - Q9958","AETNA - AETNA MCR SUPP - Q9958","AETNA - AETNA MCR SUPP - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA MCR SUPP","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9963","AETNA - AETNA MCR SUPP - Q9963","AETNA - AETNA MCR SUPP - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9963","AETNA - AETNA MCR SUPP - Q9963","AETNA - AETNA MCR SUPP - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9966","AETNA - AETNA MCR SUPP - Q9966","AETNA - AETNA MCR SUPP - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA POS - CPT - 19120","AETNA - AETNA POS - 19120","AETNA - AETNA POS - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA POS","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA POS - CPT - 29881","AETNA - AETNA POS - 29881","AETNA - AETNA POS - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA POS","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA POS - CPT - 43235","AETNA - AETNA POS - 43235","AETNA - AETNA POS - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA POS","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA POS - CPT - 43239","AETNA - AETNA POS - 43239","AETNA - AETNA POS - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA POS","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA POS - CPT - 45378","AETNA - AETNA POS - 45378","AETNA - AETNA POS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA POS - CPT - 45378","AETNA - AETNA POS - 45378","AETNA - AETNA POS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA POS - CPT - 45378","AETNA - AETNA POS - 45378","AETNA - AETNA POS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA POS - CPT - 45380","AETNA - AETNA POS - 45380","AETNA - AETNA POS - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA POS","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA POS - CPT - 45385","AETNA - AETNA POS - 45385","AETNA - AETNA POS - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA POS","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA POS - CPT - 45391","AETNA - AETNA POS - 45391","AETNA - AETNA POS - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA POS","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA POS - CPT - 55700","AETNA - AETNA POS - 55700","AETNA - AETNA POS - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA POS","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA POS - CPT - 55700","AETNA - AETNA POS - 55700","AETNA - AETNA POS - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA POS","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA POS - CPT - 62322","AETNA - AETNA POS - 62322","AETNA - AETNA POS - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA POS - CPT - 62322","AETNA - AETNA POS - 62322","AETNA - AETNA POS - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA POS - CPT - 62323","AETNA - AETNA POS - 62323","AETNA - AETNA POS - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA POS","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA POS - CPT - 64483","AETNA - AETNA POS - 64483","AETNA - AETNA POS - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA POS","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA POS - CPT - 66821","AETNA - AETNA POS - 66821","AETNA - AETNA POS - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA POS","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA POS - CPT - 66984","AETNA - AETNA POS - 66984","AETNA - AETNA POS - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA POS","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA POS - CPT - 70450","AETNA - AETNA POS - 70450","AETNA - AETNA POS - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA POS","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA POS - CPT - 70553","AETNA - AETNA POS - 70553","AETNA - AETNA POS - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA POS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA POS - CPT - 70553","AETNA - AETNA POS - 70553","AETNA - AETNA POS - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA POS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA POS - CPT - 72110","AETNA - AETNA POS - 72110","AETNA - AETNA POS - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA POS","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA POS - CPT - 72148","AETNA - AETNA POS - 72148","AETNA - AETNA POS - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA POS","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA POS - CPT - 72193","AETNA - AETNA POS - 72193","AETNA - AETNA POS - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA POS","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA POS - CPT - 73721","AETNA - AETNA POS - 73721","AETNA - AETNA POS - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA POS","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA POS - CPT - 74177","AETNA - AETNA POS - 74177","AETNA - AETNA POS - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA POS","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA POS - CPT - 76700","AETNA - AETNA POS - 76700","AETNA - AETNA POS - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA POS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA POS - CPT - 76700","AETNA - AETNA POS - 76700","AETNA - AETNA POS - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA POS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA POS - CPT - 76805","AETNA - AETNA POS - 76805","AETNA - AETNA POS - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA POS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA POS - CPT - 76805","AETNA - AETNA POS - 76805","AETNA - AETNA POS - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA POS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA POS - CPT - 76830","AETNA - AETNA POS - 76830","AETNA - AETNA POS - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA POS","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA POS - CPT - 76830","AETNA - AETNA POS - 76830","AETNA - AETNA POS - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA POS","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA POS - CPT - 77065","AETNA - AETNA POS - 77065","AETNA - AETNA POS - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA POS","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA POS - CPT - 77066","AETNA - AETNA POS - 77066","AETNA - AETNA POS - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA POS","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA POS - CPT - 77067","AETNA - AETNA POS - 77067","AETNA - AETNA POS - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA POS","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA POS - CPT - 80048","AETNA - AETNA POS - 80048","AETNA - AETNA POS - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA POS","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA POS - CPT - 80053","AETNA - AETNA POS - 80053","AETNA - AETNA POS - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA POS","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA POS - CPT - 80055","AETNA - AETNA POS - 80055","AETNA - AETNA POS - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA POS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA POS - CPT - 80061","AETNA - AETNA POS - 80061","AETNA - AETNA POS - 80061 - CHG LIPID PANEL","AETNA","AETNA POS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA POS - CPT - 80069","AETNA - AETNA POS - 80069","AETNA - AETNA POS - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA POS","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA POS - CPT - 80076","AETNA - AETNA POS - 80076","AETNA - AETNA POS - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA POS","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA POS - CPT - 81000","AETNA - AETNA POS - 81000","AETNA - AETNA POS - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA POS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA POS - CPT - 81000","AETNA - AETNA POS - 81000","AETNA - AETNA POS - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA POS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA POS - CPT - 81001","AETNA - AETNA POS - 81001","AETNA - AETNA POS - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA POS","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA POS - CPT - 81002","AETNA - AETNA POS - 81002","AETNA - AETNA POS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA POS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA POS - CPT - 81002","AETNA - AETNA POS - 81002","AETNA - AETNA POS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA POS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA POS - CPT - 81003","AETNA - AETNA POS - 81003","AETNA - AETNA POS - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA POS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA POS - CPT - 81003","AETNA - AETNA POS - 81003","AETNA - AETNA POS - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA POS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA POS - CPT - 84153","AETNA - AETNA POS - 84153","AETNA - AETNA POS - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA POS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA POS - CPT - 84443","AETNA - AETNA POS - 84443","AETNA - AETNA POS - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA POS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA POS - CPT - 85025","AETNA - AETNA POS - 85025","AETNA - AETNA POS - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA POS","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA POS - CPT - 85027","AETNA - AETNA POS - 85027","AETNA - AETNA POS - 85027 - CHG COMPLETE CBC","AETNA","AETNA POS","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA POS - CPT - 85610","AETNA - AETNA POS - 85610","AETNA - AETNA POS - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA POS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA POS - CPT - 85610","AETNA - AETNA POS - 85610","AETNA - AETNA POS - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA POS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA POS - CPT - 85730","AETNA - AETNA POS - 85730","AETNA - AETNA POS - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA POS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA POS - CPT - 85730","AETNA - AETNA POS - 85730","AETNA - AETNA POS - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA POS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA POS - CPT - 90662","AETNA - AETNA POS - 90662","AETNA - AETNA POS - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA POS","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA POS - CPT - 90686","AETNA - AETNA POS - 90686","AETNA - AETNA POS - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA POS","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA POS - CPT - 90715","AETNA - AETNA POS - 90715","AETNA - AETNA POS - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA POS","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA POS - CPT - 90832","AETNA - AETNA POS - 90832","AETNA - AETNA POS - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA POS","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA POS - CPT - 90834","AETNA - AETNA POS - 90834","AETNA - AETNA POS - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA POS","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA POS - CPT - 90837","AETNA - AETNA POS - 90837","AETNA - AETNA POS - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA POS","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA POS - CPT - 90846","AETNA - AETNA POS - 90846","AETNA - AETNA POS - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA POS","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA POS - CPT - 90847","AETNA - AETNA POS - 90847","AETNA - AETNA POS - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA POS","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA POS - CPT - 90853","AETNA - AETNA POS - 90853","AETNA - AETNA POS - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA POS","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA POS - CPT - 93452","AETNA - AETNA POS - 93452","AETNA - AETNA POS - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA POS","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA POS - CPT - 95810","AETNA - AETNA POS - 95810","AETNA - AETNA POS - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA POS","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA POS - CPT - 97110","AETNA - AETNA POS - 97110","AETNA - AETNA POS - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA POS","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA POS - CPT - 99203","AETNA - AETNA POS - 99203","AETNA - AETNA POS - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA POS - CPT - 99203","AETNA - AETNA POS - 99203","AETNA - AETNA POS - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA POS - CPT - 99204","AETNA - AETNA POS - 99204","AETNA - AETNA POS - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA POS","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA POS - CPT - 99204","AETNA - AETNA POS - 99204","AETNA - AETNA POS - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA POS","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA POS - CPT - 99205","AETNA - AETNA POS - 99205","AETNA - AETNA POS - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA POS - CPT - 99205","AETNA - AETNA POS - 99205","AETNA - AETNA POS - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA POS - CPT - 99212","AETNA - AETNA POS - 99212","AETNA - AETNA POS - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA POS - CPT - 99212","AETNA - AETNA POS - 99212","AETNA - AETNA POS - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA POS - CPT - 99213","AETNA - AETNA POS - 99213","AETNA - AETNA POS - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA POS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA POS - CPT - 99213","AETNA - AETNA POS - 99213","AETNA - AETNA POS - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA POS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA POS - CPT - 99214","AETNA - AETNA POS - 99214","AETNA - AETNA POS - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA POS","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA POS - CPT - 99214","AETNA - AETNA POS - 99214","AETNA - AETNA POS - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA POS","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA POS - CPT - 99215","AETNA - AETNA POS - 99215","AETNA - AETNA POS - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA POS","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA POS - CPT - 99215","AETNA - AETNA POS - 99215","AETNA - AETNA POS - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA POS","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA POS - CPT - 99385","AETNA - AETNA POS - 99385","AETNA - AETNA POS - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA POS","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA POS - CPT - 99386","AETNA - AETNA POS - 99386","AETNA - AETNA POS - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA POS","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA POS - CPT - A9500","AETNA - AETNA POS - A9500","AETNA - AETNA POS - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA POS","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AETNA - AETNA POS - CPT - A9513","AETNA - AETNA POS - A9513","AETNA - AETNA POS - A9513 - DELETED 2077","AETNA","AETNA POS","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25]
["AETNA - AETNA POS - CPT - A9517","AETNA - AETNA POS - A9517","AETNA - AETNA POS - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA POS","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA POS - CPT - A9552","AETNA - AETNA POS - A9552","AETNA - AETNA POS - A9552 - PR F18 FDG","AETNA","AETNA POS","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AETNA - AETNA POS - CPT - A9555","AETNA - AETNA POS - A9555","AETNA - AETNA POS - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA POS","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AETNA - AETNA POS - CPT - A9575","AETNA - AETNA POS - A9575","AETNA - AETNA POS - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA POS","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AETNA - AETNA POS - CPT - A9579","AETNA - AETNA POS - A9579","AETNA - AETNA POS - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["AETNA - AETNA POS - CPT - A9579","AETNA - AETNA POS - A9579","AETNA - AETNA POS - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["AETNA - AETNA POS - CPT - A9581","AETNA - AETNA POS - A9581","AETNA - AETNA POS - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA POS","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AETNA - AETNA POS - CPT - J1030","AETNA - AETNA POS - J1030","AETNA - AETNA POS - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA POS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA POS - CPT - J3301","AETNA - AETNA POS - J3301","AETNA - AETNA POS - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA POS","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA POS - CPT - P9047","AETNA - AETNA POS - P9047","AETNA - AETNA POS - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA POS","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA POS - CPT - Q9958","AETNA - AETNA POS - Q9958","AETNA - AETNA POS - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA POS","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9963","AETNA - AETNA POS - Q9963","AETNA - AETNA POS - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9963","AETNA - AETNA POS - Q9963","AETNA - AETNA POS - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9966","AETNA - AETNA POS - Q9966","AETNA - AETNA POS - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AETNA - AETNA PPO EPO - CPT - 19120","AETNA - AETNA PPO EPO - 19120","AETNA - AETNA PPO EPO - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA PPO EPO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA PPO EPO - CPT - 29881","AETNA - AETNA PPO EPO - 29881","AETNA - AETNA PPO EPO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA PPO EPO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA PPO EPO - CPT - 43235","AETNA - AETNA PPO EPO - 43235","AETNA - AETNA PPO EPO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA PPO EPO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA PPO EPO - CPT - 43239","AETNA - AETNA PPO EPO - 43239","AETNA - AETNA PPO EPO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA PPO EPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA - AETNA PPO EPO - 45378","AETNA - AETNA PPO EPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA - AETNA PPO EPO - 45378","AETNA - AETNA PPO EPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA - AETNA PPO EPO - 45378","AETNA - AETNA PPO EPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA PPO EPO - CPT - 45380","AETNA - AETNA PPO EPO - 45380","AETNA - AETNA PPO EPO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA PPO EPO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA PPO EPO - CPT - 45385","AETNA - AETNA PPO EPO - 45385","AETNA - AETNA PPO EPO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA PPO EPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA PPO EPO - CPT - 45391","AETNA - AETNA PPO EPO - 45391","AETNA - AETNA PPO EPO - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA PPO EPO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA PPO EPO - CPT - 55700","AETNA - AETNA PPO EPO - 55700","AETNA - AETNA PPO EPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA PPO EPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA PPO EPO - CPT - 55700","AETNA - AETNA PPO EPO - 55700","AETNA - AETNA PPO EPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA PPO EPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA PPO EPO - CPT - 62322","AETNA - AETNA PPO EPO - 62322","AETNA - AETNA PPO EPO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA PPO EPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA PPO EPO - CPT - 62322","AETNA - AETNA PPO EPO - 62322","AETNA - AETNA PPO EPO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA PPO EPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA PPO EPO - CPT - 62323","AETNA - AETNA PPO EPO - 62323","AETNA - AETNA PPO EPO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA PPO EPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA PPO EPO - CPT - 64483","AETNA - AETNA PPO EPO - 64483","AETNA - AETNA PPO EPO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA PPO EPO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA PPO EPO - CPT - 66821","AETNA - AETNA PPO EPO - 66821","AETNA - AETNA PPO EPO - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA PPO EPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA PPO EPO - CPT - 66984","AETNA - AETNA PPO EPO - 66984","AETNA - AETNA PPO EPO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA PPO EPO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA PPO EPO - CPT - 70450","AETNA - AETNA PPO EPO - 70450","AETNA - AETNA PPO EPO - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA PPO EPO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA PPO EPO - CPT - 70553","AETNA - AETNA PPO EPO - 70553","AETNA - AETNA PPO EPO - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA PPO EPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA PPO EPO - CPT - 70553","AETNA - AETNA PPO EPO - 70553","AETNA - AETNA PPO EPO - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA PPO EPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA PPO EPO - CPT - 72110","AETNA - AETNA PPO EPO - 72110","AETNA - AETNA PPO EPO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA PPO EPO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA PPO EPO - CPT - 72148","AETNA - AETNA PPO EPO - 72148","AETNA - AETNA PPO EPO - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA PPO EPO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA PPO EPO - CPT - 72193","AETNA - AETNA PPO EPO - 72193","AETNA - AETNA PPO EPO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA PPO EPO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA PPO EPO - CPT - 73721","AETNA - AETNA PPO EPO - 73721","AETNA - AETNA PPO EPO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA PPO EPO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA PPO EPO - CPT - 74177","AETNA - AETNA PPO EPO - 74177","AETNA - AETNA PPO EPO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA PPO EPO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA PPO EPO - CPT - 76700","AETNA - AETNA PPO EPO - 76700","AETNA - AETNA PPO EPO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA PPO EPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA PPO EPO - CPT - 76700","AETNA - AETNA PPO EPO - 76700","AETNA - AETNA PPO EPO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA PPO EPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA PPO EPO - CPT - 76805","AETNA - AETNA PPO EPO - 76805","AETNA - AETNA PPO EPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA PPO EPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA PPO EPO - CPT - 76805","AETNA - AETNA PPO EPO - 76805","AETNA - AETNA PPO EPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA PPO EPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA PPO EPO - CPT - 76830","AETNA - AETNA PPO EPO - 76830","AETNA - AETNA PPO EPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA PPO EPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA PPO EPO - CPT - 76830","AETNA - AETNA PPO EPO - 76830","AETNA - AETNA PPO EPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA PPO EPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA PPO EPO - CPT - 77065","AETNA - AETNA PPO EPO - 77065","AETNA - AETNA PPO EPO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA PPO EPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA PPO EPO - CPT - 77066","AETNA - AETNA PPO EPO - 77066","AETNA - AETNA PPO EPO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA PPO EPO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA PPO EPO - CPT - 77067","AETNA - AETNA PPO EPO - 77067","AETNA - AETNA PPO EPO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA PPO EPO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA PPO EPO - CPT - 80048","AETNA - AETNA PPO EPO - 80048","AETNA - AETNA PPO EPO - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA PPO EPO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA PPO EPO - CPT - 80053","AETNA - AETNA PPO EPO - 80053","AETNA - AETNA PPO EPO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA PPO EPO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA PPO EPO - CPT - 80055","AETNA - AETNA PPO EPO - 80055","AETNA - AETNA PPO EPO - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA PPO EPO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA PPO EPO - CPT - 80061","AETNA - AETNA PPO EPO - 80061","AETNA - AETNA PPO EPO - 80061 - CHG LIPID PANEL","AETNA","AETNA PPO EPO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA PPO EPO - CPT - 80069","AETNA - AETNA PPO EPO - 80069","AETNA - AETNA PPO EPO - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA PPO EPO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA PPO EPO - CPT - 80076","AETNA - AETNA PPO EPO - 80076","AETNA - AETNA PPO EPO - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA PPO EPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA PPO EPO - CPT - 81000","AETNA - AETNA PPO EPO - 81000","AETNA - AETNA PPO EPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA PPO EPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA PPO EPO - CPT - 81000","AETNA - AETNA PPO EPO - 81000","AETNA - AETNA PPO EPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA PPO EPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA PPO EPO - CPT - 81001","AETNA - AETNA PPO EPO - 81001","AETNA - AETNA PPO EPO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA PPO EPO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA PPO EPO - CPT - 81002","AETNA - AETNA PPO EPO - 81002","AETNA - AETNA PPO EPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA PPO EPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA PPO EPO - CPT - 81002","AETNA - AETNA PPO EPO - 81002","AETNA - AETNA PPO EPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA PPO EPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA PPO EPO - CPT - 81003","AETNA - AETNA PPO EPO - 81003","AETNA - AETNA PPO EPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA PPO EPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA PPO EPO - CPT - 81003","AETNA - AETNA PPO EPO - 81003","AETNA - AETNA PPO EPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA PPO EPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA PPO EPO - CPT - 84153","AETNA - AETNA PPO EPO - 84153","AETNA - AETNA PPO EPO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA PPO EPO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA PPO EPO - CPT - 84443","AETNA - AETNA PPO EPO - 84443","AETNA - AETNA PPO EPO - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA PPO EPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA PPO EPO - CPT - 85025","AETNA - AETNA PPO EPO - 85025","AETNA - AETNA PPO EPO - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA PPO EPO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA PPO EPO - CPT - 85027","AETNA - AETNA PPO EPO - 85027","AETNA - AETNA PPO EPO - 85027 - CHG COMPLETE CBC","AETNA","AETNA PPO EPO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA PPO EPO - CPT - 85610","AETNA - AETNA PPO EPO - 85610","AETNA - AETNA PPO EPO - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA PPO EPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA PPO EPO - CPT - 85610","AETNA - AETNA PPO EPO - 85610","AETNA - AETNA PPO EPO - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA PPO EPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA PPO EPO - CPT - 85730","AETNA - AETNA PPO EPO - 85730","AETNA - AETNA PPO EPO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA PPO EPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA PPO EPO - CPT - 85730","AETNA - AETNA PPO EPO - 85730","AETNA - AETNA PPO EPO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA PPO EPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA PPO EPO - CPT - 90662","AETNA - AETNA PPO EPO - 90662","AETNA - AETNA PPO EPO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA PPO EPO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA PPO EPO - CPT - 90686","AETNA - AETNA PPO EPO - 90686","AETNA - AETNA PPO EPO - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA PPO EPO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA PPO EPO - CPT - 90715","AETNA - AETNA PPO EPO - 90715","AETNA - AETNA PPO EPO - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA PPO EPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA PPO EPO - CPT - 90832","AETNA - AETNA PPO EPO - 90832","AETNA - AETNA PPO EPO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA PPO EPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA PPO EPO - CPT - 90834","AETNA - AETNA PPO EPO - 90834","AETNA - AETNA PPO EPO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA PPO EPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA PPO EPO - CPT - 90837","AETNA - AETNA PPO EPO - 90837","AETNA - AETNA PPO EPO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA PPO EPO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA PPO EPO - CPT - 90846","AETNA - AETNA PPO EPO - 90846","AETNA - AETNA PPO EPO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA PPO EPO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA PPO EPO - CPT - 90847","AETNA - AETNA PPO EPO - 90847","AETNA - AETNA PPO EPO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA PPO EPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA PPO EPO - CPT - 90853","AETNA - AETNA PPO EPO - 90853","AETNA - AETNA PPO EPO - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA PPO EPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA PPO EPO - CPT - 93452","AETNA - AETNA PPO EPO - 93452","AETNA - AETNA PPO EPO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA PPO EPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA PPO EPO - CPT - 95810","AETNA - AETNA PPO EPO - 95810","AETNA - AETNA PPO EPO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA PPO EPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA PPO EPO - CPT - 97110","AETNA - AETNA PPO EPO - 97110","AETNA - AETNA PPO EPO - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA PPO EPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA PPO EPO - CPT - 99203","AETNA - AETNA PPO EPO - 99203","AETNA - AETNA PPO EPO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA PPO EPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA PPO EPO - CPT - 99203","AETNA - AETNA PPO EPO - 99203","AETNA - AETNA PPO EPO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA PPO EPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA PPO EPO - CPT - 99204","AETNA - AETNA PPO EPO - 99204","AETNA - AETNA PPO EPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA PPO EPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA PPO EPO - CPT - 99204","AETNA - AETNA PPO EPO - 99204","AETNA - AETNA PPO EPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA PPO EPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA PPO EPO - CPT - 99205","AETNA - AETNA PPO EPO - 99205","AETNA - AETNA PPO EPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA PPO EPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA PPO EPO - CPT - 99205","AETNA - AETNA PPO EPO - 99205","AETNA - AETNA PPO EPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA PPO EPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA PPO EPO - CPT - 99212","AETNA - AETNA PPO EPO - 99212","AETNA - AETNA PPO EPO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA PPO EPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA PPO EPO - CPT - 99212","AETNA - AETNA PPO EPO - 99212","AETNA - AETNA PPO EPO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA PPO EPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA PPO EPO - CPT - 99213","AETNA - AETNA PPO EPO - 99213","AETNA - AETNA PPO EPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA PPO EPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA PPO EPO - CPT - 99213","AETNA - AETNA PPO EPO - 99213","AETNA - AETNA PPO EPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA PPO EPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA PPO EPO - CPT - 99214","AETNA - AETNA PPO EPO - 99214","AETNA - AETNA PPO EPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA PPO EPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA PPO EPO - CPT - 99214","AETNA - AETNA PPO EPO - 99214","AETNA - AETNA PPO EPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA PPO EPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA PPO EPO - CPT - 99215","AETNA - AETNA PPO EPO - 99215","AETNA - AETNA PPO EPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA PPO EPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA PPO EPO - CPT - 99215","AETNA - AETNA PPO EPO - 99215","AETNA - AETNA PPO EPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA PPO EPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA PPO EPO - CPT - 99385","AETNA - AETNA PPO EPO - 99385","AETNA - AETNA PPO EPO - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA PPO EPO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA PPO EPO - CPT - 99386","AETNA - AETNA PPO EPO - 99386","AETNA - AETNA PPO EPO - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA PPO EPO","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA PPO EPO - CPT - A9500","AETNA - AETNA PPO EPO - A9500","AETNA - AETNA PPO EPO - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA PPO EPO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AETNA - AETNA PPO EPO - CPT - A9513","AETNA - AETNA PPO EPO - A9513","AETNA - AETNA PPO EPO - A9513 - DELETED 2077","AETNA","AETNA PPO EPO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25]
["AETNA - AETNA PPO EPO - CPT - A9517","AETNA - AETNA PPO EPO - A9517","AETNA - AETNA PPO EPO - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA PPO EPO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA PPO EPO - CPT - A9552","AETNA - AETNA PPO EPO - A9552","AETNA - AETNA PPO EPO - A9552 - PR F18 FDG","AETNA","AETNA PPO EPO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AETNA - AETNA PPO EPO - CPT - A9555","AETNA - AETNA PPO EPO - A9555","AETNA - AETNA PPO EPO - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA PPO EPO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AETNA - AETNA PPO EPO - CPT - A9575","AETNA - AETNA PPO EPO - A9575","AETNA - AETNA PPO EPO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA PPO EPO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AETNA - AETNA PPO EPO - CPT - A9579","AETNA - AETNA PPO EPO - A9579","AETNA - AETNA PPO EPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA PPO EPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["AETNA - AETNA PPO EPO - CPT - A9579","AETNA - AETNA PPO EPO - A9579","AETNA - AETNA PPO EPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA PPO EPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["AETNA - AETNA PPO EPO - CPT - A9581","AETNA - AETNA PPO EPO - A9581","AETNA - AETNA PPO EPO - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA PPO EPO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AETNA - AETNA PPO EPO - CPT - J1030","AETNA - AETNA PPO EPO - J1030","AETNA - AETNA PPO EPO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA PPO EPO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA PPO EPO - CPT - J3301","AETNA - AETNA PPO EPO - J3301","AETNA - AETNA PPO EPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA PPO EPO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA PPO EPO - CPT - P9047","AETNA - AETNA PPO EPO - P9047","AETNA - AETNA PPO EPO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA PPO EPO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA PPO EPO - CPT - Q9958","AETNA - AETNA PPO EPO - Q9958","AETNA - AETNA PPO EPO - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA PPO EPO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9963","AETNA - AETNA PPO EPO - Q9963","AETNA - AETNA PPO EPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9963","AETNA - AETNA PPO EPO - Q9963","AETNA - AETNA PPO EPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9966","AETNA - AETNA PPO EPO - Q9966","AETNA - AETNA PPO EPO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 19120","AETNA - AETNA STUDENT HEALTH - 19120","AETNA - AETNA STUDENT HEALTH - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA STUDENT HEALTH","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 29881","AETNA - AETNA STUDENT HEALTH - 29881","AETNA - AETNA STUDENT HEALTH - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA STUDENT HEALTH","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 43235","AETNA - AETNA STUDENT HEALTH - 43235","AETNA - AETNA STUDENT HEALTH - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA STUDENT HEALTH","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 43239","AETNA - AETNA STUDENT HEALTH - 43239","AETNA - AETNA STUDENT HEALTH - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA STUDENT HEALTH","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA - AETNA STUDENT HEALTH - 45378","AETNA - AETNA STUDENT HEALTH - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA - AETNA STUDENT HEALTH - 45378","AETNA - AETNA STUDENT HEALTH - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA - AETNA STUDENT HEALTH - 45378","AETNA - AETNA STUDENT HEALTH - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 45380","AETNA - AETNA STUDENT HEALTH - 45380","AETNA - AETNA STUDENT HEALTH - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA STUDENT HEALTH","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 45385","AETNA - AETNA STUDENT HEALTH - 45385","AETNA - AETNA STUDENT HEALTH - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA STUDENT HEALTH","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA STUDENT HEALTH - CPT - 45391","AETNA - AETNA STUDENT HEALTH - 45391","AETNA - AETNA STUDENT HEALTH - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA STUDENT HEALTH","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA STUDENT HEALTH - CPT - 55700","AETNA - AETNA STUDENT HEALTH - 55700","AETNA - AETNA STUDENT HEALTH - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA STUDENT HEALTH","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA STUDENT HEALTH - CPT - 55700","AETNA - AETNA STUDENT HEALTH - 55700","AETNA - AETNA STUDENT HEALTH - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA STUDENT HEALTH","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA STUDENT HEALTH - CPT - 62322","AETNA - AETNA STUDENT HEALTH - 62322","AETNA - AETNA STUDENT HEALTH - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA STUDENT HEALTH","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 62322","AETNA - AETNA STUDENT HEALTH - 62322","AETNA - AETNA STUDENT HEALTH - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA STUDENT HEALTH","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 62323","AETNA - AETNA STUDENT HEALTH - 62323","AETNA - AETNA STUDENT HEALTH - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA STUDENT HEALTH","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 64483","AETNA - AETNA STUDENT HEALTH - 64483","AETNA - AETNA STUDENT HEALTH - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA STUDENT HEALTH","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 66821","AETNA - AETNA STUDENT HEALTH - 66821","AETNA - AETNA STUDENT HEALTH - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA STUDENT HEALTH","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 66984","AETNA - AETNA STUDENT HEALTH - 66984","AETNA - AETNA STUDENT HEALTH - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA STUDENT HEALTH","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA STUDENT HEALTH - CPT - 70450","AETNA - AETNA STUDENT HEALTH - 70450","AETNA - AETNA STUDENT HEALTH - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA STUDENT HEALTH","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 70553","AETNA - AETNA STUDENT HEALTH - 70553","AETNA - AETNA STUDENT HEALTH - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA STUDENT HEALTH","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 70553","AETNA - AETNA STUDENT HEALTH - 70553","AETNA - AETNA STUDENT HEALTH - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA STUDENT HEALTH","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 72110","AETNA - AETNA STUDENT HEALTH - 72110","AETNA - AETNA STUDENT HEALTH - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA STUDENT HEALTH","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 72148","AETNA - AETNA STUDENT HEALTH - 72148","AETNA - AETNA STUDENT HEALTH - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA STUDENT HEALTH","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 72193","AETNA - AETNA STUDENT HEALTH - 72193","AETNA - AETNA STUDENT HEALTH - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA STUDENT HEALTH","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA STUDENT HEALTH - CPT - 73721","AETNA - AETNA STUDENT HEALTH - 73721","AETNA - AETNA STUDENT HEALTH - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA STUDENT HEALTH","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA STUDENT HEALTH - CPT - 74177","AETNA - AETNA STUDENT HEALTH - 74177","AETNA - AETNA STUDENT HEALTH - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA STUDENT HEALTH","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 76700","AETNA - AETNA STUDENT HEALTH - 76700","AETNA - AETNA STUDENT HEALTH - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA STUDENT HEALTH","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 76700","AETNA - AETNA STUDENT HEALTH - 76700","AETNA - AETNA STUDENT HEALTH - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA STUDENT HEALTH","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 76805","AETNA - AETNA STUDENT HEALTH - 76805","AETNA - AETNA STUDENT HEALTH - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA STUDENT HEALTH","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA STUDENT HEALTH - CPT - 76805","AETNA - AETNA STUDENT HEALTH - 76805","AETNA - AETNA STUDENT HEALTH - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA STUDENT HEALTH","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA STUDENT HEALTH - CPT - 76830","AETNA - AETNA STUDENT HEALTH - 76830","AETNA - AETNA STUDENT HEALTH - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA STUDENT HEALTH - CPT - 76830","AETNA - AETNA STUDENT HEALTH - 76830","AETNA - AETNA STUDENT HEALTH - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA STUDENT HEALTH - CPT - 77065","AETNA - AETNA STUDENT HEALTH - 77065","AETNA - AETNA STUDENT HEALTH - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA STUDENT HEALTH","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA STUDENT HEALTH - CPT - 77066","AETNA - AETNA STUDENT HEALTH - 77066","AETNA - AETNA STUDENT HEALTH - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA STUDENT HEALTH","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA STUDENT HEALTH - CPT - 77067","AETNA - AETNA STUDENT HEALTH - 77067","AETNA - AETNA STUDENT HEALTH - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA STUDENT HEALTH","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA STUDENT HEALTH - CPT - 80048","AETNA - AETNA STUDENT HEALTH - 80048","AETNA - AETNA STUDENT HEALTH - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA STUDENT HEALTH","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 80053","AETNA - AETNA STUDENT HEALTH - 80053","AETNA - AETNA STUDENT HEALTH - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA STUDENT HEALTH","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 80055","AETNA - AETNA STUDENT HEALTH - 80055","AETNA - AETNA STUDENT HEALTH - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA STUDENT HEALTH","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA STUDENT HEALTH - CPT - 80061","AETNA - AETNA STUDENT HEALTH - 80061","AETNA - AETNA STUDENT HEALTH - 80061 - CHG LIPID PANEL","AETNA","AETNA STUDENT HEALTH","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 80069","AETNA - AETNA STUDENT HEALTH - 80069","AETNA - AETNA STUDENT HEALTH - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA STUDENT HEALTH","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 80076","AETNA - AETNA STUDENT HEALTH - 80076","AETNA - AETNA STUDENT HEALTH - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA STUDENT HEALTH","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 81000","AETNA - AETNA STUDENT HEALTH - 81000","AETNA - AETNA STUDENT HEALTH - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA STUDENT HEALTH - CPT - 81000","AETNA - AETNA STUDENT HEALTH - 81000","AETNA - AETNA STUDENT HEALTH - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA STUDENT HEALTH - CPT - 81001","AETNA - AETNA STUDENT HEALTH - 81001","AETNA - AETNA STUDENT HEALTH - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA STUDENT HEALTH - CPT - 81002","AETNA - AETNA STUDENT HEALTH - 81002","AETNA - AETNA STUDENT HEALTH - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 81002","AETNA - AETNA STUDENT HEALTH - 81002","AETNA - AETNA STUDENT HEALTH - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 81003","AETNA - AETNA STUDENT HEALTH - 81003","AETNA - AETNA STUDENT HEALTH - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 81003","AETNA - AETNA STUDENT HEALTH - 81003","AETNA - AETNA STUDENT HEALTH - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 84153","AETNA - AETNA STUDENT HEALTH - 84153","AETNA - AETNA STUDENT HEALTH - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA STUDENT HEALTH","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 84443","AETNA - AETNA STUDENT HEALTH - 84443","AETNA - AETNA STUDENT HEALTH - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA STUDENT HEALTH","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 85025","AETNA - AETNA STUDENT HEALTH - 85025","AETNA - AETNA STUDENT HEALTH - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA STUDENT HEALTH","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 85027","AETNA - AETNA STUDENT HEALTH - 85027","AETNA - AETNA STUDENT HEALTH - 85027 - CHG COMPLETE CBC","AETNA","AETNA STUDENT HEALTH","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 85610","AETNA - AETNA STUDENT HEALTH - 85610","AETNA - AETNA STUDENT HEALTH - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA STUDENT HEALTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 85610","AETNA - AETNA STUDENT HEALTH - 85610","AETNA - AETNA STUDENT HEALTH - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA STUDENT HEALTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 85730","AETNA - AETNA STUDENT HEALTH - 85730","AETNA - AETNA STUDENT HEALTH - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA STUDENT HEALTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 85730","AETNA - AETNA STUDENT HEALTH - 85730","AETNA - AETNA STUDENT HEALTH - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA STUDENT HEALTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 90662","AETNA - AETNA STUDENT HEALTH - 90662","AETNA - AETNA STUDENT HEALTH - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA STUDENT HEALTH","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 90686","AETNA - AETNA STUDENT HEALTH - 90686","AETNA - AETNA STUDENT HEALTH - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA STUDENT HEALTH","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 90715","AETNA - AETNA STUDENT HEALTH - 90715","AETNA - AETNA STUDENT HEALTH - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA STUDENT HEALTH","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA STUDENT HEALTH - CPT - 90832","AETNA - AETNA STUDENT HEALTH - 90832","AETNA - AETNA STUDENT HEALTH - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA STUDENT HEALTH - CPT - 90834","AETNA - AETNA STUDENT HEALTH - 90834","AETNA - AETNA STUDENT HEALTH - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 90837","AETNA - AETNA STUDENT HEALTH - 90837","AETNA - AETNA STUDENT HEALTH - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 90846","AETNA - AETNA STUDENT HEALTH - 90846","AETNA - AETNA STUDENT HEALTH - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA STUDENT HEALTH","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA STUDENT HEALTH - CPT - 90847","AETNA - AETNA STUDENT HEALTH - 90847","AETNA - AETNA STUDENT HEALTH - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA STUDENT HEALTH","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 90853","AETNA - AETNA STUDENT HEALTH - 90853","AETNA - AETNA STUDENT HEALTH - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA STUDENT HEALTH","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 93452","AETNA - AETNA STUDENT HEALTH - 93452","AETNA - AETNA STUDENT HEALTH - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA STUDENT HEALTH","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 95810","AETNA - AETNA STUDENT HEALTH - 95810","AETNA - AETNA STUDENT HEALTH - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA STUDENT HEALTH","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 97110","AETNA - AETNA STUDENT HEALTH - 97110","AETNA - AETNA STUDENT HEALTH - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA STUDENT HEALTH","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99203","AETNA - AETNA STUDENT HEALTH - 99203","AETNA - AETNA STUDENT HEALTH - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99203","AETNA - AETNA STUDENT HEALTH - 99203","AETNA - AETNA STUDENT HEALTH - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99204","AETNA - AETNA STUDENT HEALTH - 99204","AETNA - AETNA STUDENT HEALTH - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99204","AETNA - AETNA STUDENT HEALTH - 99204","AETNA - AETNA STUDENT HEALTH - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99205","AETNA - AETNA STUDENT HEALTH - 99205","AETNA - AETNA STUDENT HEALTH - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99205","AETNA - AETNA STUDENT HEALTH - 99205","AETNA - AETNA STUDENT HEALTH - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99212","AETNA - AETNA STUDENT HEALTH - 99212","AETNA - AETNA STUDENT HEALTH - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99212","AETNA - AETNA STUDENT HEALTH - 99212","AETNA - AETNA STUDENT HEALTH - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99213","AETNA - AETNA STUDENT HEALTH - 99213","AETNA - AETNA STUDENT HEALTH - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99213","AETNA - AETNA STUDENT HEALTH - 99213","AETNA - AETNA STUDENT HEALTH - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99214","AETNA - AETNA STUDENT HEALTH - 99214","AETNA - AETNA STUDENT HEALTH - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 99214","AETNA - AETNA STUDENT HEALTH - 99214","AETNA - AETNA STUDENT HEALTH - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 99215","AETNA - AETNA STUDENT HEALTH - 99215","AETNA - AETNA STUDENT HEALTH - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99215","AETNA - AETNA STUDENT HEALTH - 99215","AETNA - AETNA STUDENT HEALTH - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99385","AETNA - AETNA STUDENT HEALTH - 99385","AETNA - AETNA STUDENT HEALTH - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA STUDENT HEALTH","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 99386","AETNA - AETNA STUDENT HEALTH - 99386","AETNA - AETNA STUDENT HEALTH - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA STUDENT HEALTH","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA STUDENT HEALTH - CPT - A9500","AETNA - AETNA STUDENT HEALTH - A9500","AETNA - AETNA STUDENT HEALTH - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA STUDENT HEALTH","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,188.85,128.52000000000001,456.36,89.25]
["AETNA - AETNA STUDENT HEALTH - CPT - A9513","AETNA - AETNA STUDENT HEALTH - A9513","AETNA - AETNA STUDENT HEALTH - A9513 - DELETED 2077","AETNA","AETNA STUDENT HEALTH","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,226.94,154.44,456.36,107.25]
["AETNA - AETNA STUDENT HEALTH - CPT - A9517","AETNA - AETNA STUDENT HEALTH - A9517","AETNA - AETNA STUDENT HEALTH - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA STUDENT HEALTH","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA STUDENT HEALTH - CPT - A9552","AETNA - AETNA STUDENT HEALTH - A9552","AETNA - AETNA STUDENT HEALTH - A9552 - PR F18 FDG","AETNA","AETNA STUDENT HEALTH","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,536.94000000000005,365.4,1015,253.75]
["AETNA - AETNA STUDENT HEALTH - CPT - A9555","AETNA - AETNA STUDENT HEALTH - A9555","AETNA - AETNA STUDENT HEALTH - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA STUDENT HEALTH","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,732.67,420.34,1385,346.25]
["AETNA - AETNA STUDENT HEALTH - CPT - A9575","AETNA - AETNA STUDENT HEALTH - A9575","AETNA - AETNA STUDENT HEALTH - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA STUDENT HEALTH","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,4.2300000000000004,0.13,456.36,2]
["AETNA - AETNA STUDENT HEALTH - CPT - A9579","AETNA - AETNA STUDENT HEALTH - A9579","AETNA - AETNA STUDENT HEALTH - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA STUDENT HEALTH","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,1.59,1.08,456.36,0.75]
["AETNA - AETNA STUDENT HEALTH - CPT - A9579","AETNA - AETNA STUDENT HEALTH - A9579","AETNA - AETNA STUDENT HEALTH - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA STUDENT HEALTH","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.65,1.57,456.36,1.25]
["AETNA - AETNA STUDENT HEALTH - CPT - A9581","AETNA - AETNA STUDENT HEALTH - A9581","AETNA - AETNA STUDENT HEALTH - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA STUDENT HEALTH","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,52.37,15.3,456.36,24.75]
["AETNA - AETNA STUDENT HEALTH - CPT - J1030","AETNA - AETNA STUDENT HEALTH - J1030","AETNA - AETNA STUDENT HEALTH - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA STUDENT HEALTH","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA STUDENT HEALTH - CPT - J3301","AETNA - AETNA STUDENT HEALTH - J3301","AETNA - AETNA STUDENT HEALTH - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA STUDENT HEALTH","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA STUDENT HEALTH - CPT - P9047","AETNA - AETNA STUDENT HEALTH - P9047","AETNA - AETNA STUDENT HEALTH - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA STUDENT HEALTH","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9958","AETNA - AETNA STUDENT HEALTH - Q9958","AETNA - AETNA STUDENT HEALTH - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,0.53,0.09,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9963","AETNA - AETNA STUDENT HEALTH - Q9963","AETNA - AETNA STUDENT HEALTH - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.53,0.22,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9963","AETNA - AETNA STUDENT HEALTH - Q9963","AETNA - AETNA STUDENT HEALTH - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.53,0.22,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9966","AETNA - AETNA STUDENT HEALTH - Q9966","AETNA - AETNA STUDENT HEALTH - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,0.53,0.36,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,1.06,0.12,456.36,0.5]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,1.06,0.12,456.36,0.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 19120","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 19120","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 19120 - PR EXCISE BREAST CYST","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 29881","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 29881","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 43235","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 43235","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 43239","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 43239","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45380","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45380","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45385","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45385","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45391","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45391","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 55700","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 55700","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 55700","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 55700","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62322","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62322","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62322","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62322","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62323","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62323","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 64483","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 64483","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 66821","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 66821","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 66984","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 66984","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70450","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70450","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70553","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70553","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70553 - CHG MRI BRAIN COMBO","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70553","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70553","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70553 - CHG MRI BRAIN COMBO","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72110","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72110","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72148","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72148","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72148 - CHG MRI, LUMBAR SPINE","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72193","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72193","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 73721","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 73721","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 74177","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 74177","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - A9513","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - A9513","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - A9513 - DELETED 2077","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["BCBS - BCBS HMO - CPT - 85610","BCBS - BCBS HMO - 85610","BCBS - BCBS HMO - 85610 - CHG PROTHROMBIN TIME","BCBS","BCBS HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,7.45,3.58,456.36,7.25]
["BCBS - BCBS INDEMNITY - CPT - J3301","BCBS - BCBS INDEMNITY - J3301","BCBS - BCBS INDEMNITY - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","BCBS","BCBS INDEMNITY","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["BCBS - BCBS POS - CPT - 66984","BCBS - BCBS POS - 66984","BCBS - BCBS POS - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","BCBS","BCBS POS","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,3527.53,420.34,4241.13,556]
["BCBS - BCBS POS - CPT - A9579","BCBS - BCBS POS - A9579","BCBS - BCBS POS - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BCBS","BCBS POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["BCBS - BCBS PPO - CPT - A9575","BCBS - BCBS PPO - A9575","BCBS - BCBS PPO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","BCBS","BCBS PPO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["BCBS - BCBS STANDARD - CPT - 81001","BCBS - BCBS STANDARD - 81001","BCBS - BCBS STANDARD - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","BCBS","BCBS STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,6.3,2.8,456.36,6]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 45385","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - 45385","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1802.8,420.34,2929.62,760]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 80069","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - 80069","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - 80069 - CHG RENAL FUNCTION PANEL","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,17.18,7.66,456.36,48.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 99215","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - 99215","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 84153","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - 84153","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 74177","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - 74177","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,961.1,398.75,2773.55,815.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 62323","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - 62323","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1101.79,420.34,1505.24,371.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 95810","BCBS OUT OF STATE - BCBS OUT OF STATE POS - 95810","BCBS OUT OF STATE - BCBS OUT OF STATE POS - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1679.52,420.34,3344.75,983.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - A9552","BCBS OUT OF STATE - BCBS OUT OF STATE POS - A9552","BCBS OUT OF STATE - BCBS OUT OF STATE POS - A9552 - PR F18 FDG","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["CCA - CCA SCO ONECARE - CPT - 80076","CCA - CCA SCO ONECARE - 80076","CCA - CCA SCO ONECARE - 80076 - CHG HEPATIC FUNCTION PANEL","CCA","CCA SCO ONECARE","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.58,7.21,456.36,40.75]
["CCA - CCA SCO STANDARD - CPT - 70553","CCA - CCA SCO STANDARD - 70553","CCA - CCA SCO STANDARD - 70553 - CHG MRI BRAIN COMBO","CCA","CCA SCO STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,453.39,398.75,5879.45,1729.25]
["CCA - ZZZCCA STANDARD - CPT - 62322","CCA - ZZZCCA STANDARD - 62322","CCA - ZZZCCA STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CCA","ZZZCCA STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["CCA - ZZZCCA STANDARD - CPT - A9579","CCA - ZZZCCA STANDARD - A9579","CCA - ZZZCCA STANDARD - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CCA","ZZZCCA STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 62323","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - 62323","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,815.3,420.34,1505.24,371.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 90834","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - 90834","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,187.97,27.84,456.36,53.75]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 90853","CCA MEDICARE PREFERRED - ZZZCCA - 90853","CCA MEDICARE PREFERRED - ZZZCCA - 90853 - PR GROUP PSYCHOTHERAPY","CCA MEDICARE PREFERRED","ZZZCCA","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,105.09,15.63,456.36,32.25]
["CIGNA - CIGNA CARELINK - CPT - 66984","CIGNA - CIGNA CARELINK - 66984","CIGNA - CIGNA CARELINK - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","CIGNA","CIGNA CARELINK","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,3587.95,420.34,4241.13,556]
["CIGNA - CIGNA CARELINK - CPT - Q9967","CIGNA - CIGNA CARELINK - Q9967","CIGNA - CIGNA CARELINK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CIGNA","CIGNA CARELINK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["CIGNA - CIGNA STANDARD - CPT - 76700","CIGNA - CIGNA STANDARD - 76700","CIGNA - CIGNA STANDARD - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","CIGNA","CIGNA STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,961.35,111.92,961.35,282.75]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 90715","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - 90715","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - 90715 - PR TDAP VACCINE >7 YO, IM","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 74177","CORRECTIONS - CORRECTIONS BRISTOL - 74177","CORRECTIONS - CORRECTIONS BRISTOL - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","CORRECTIONS","CORRECTIONS BRISTOL","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,453.39,398.75,2773.55,815.75]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 66821","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - 66821","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - 66821 - PR DISCISSION,2ND CATARACT,LASER","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,685.29,420.34,2389.35,702.75]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - Q9967","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - Q9967","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 29881","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - 29881","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 55700","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - 55700","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 81001","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - 81001","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.33,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 81003","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - 81003","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 62322","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - 62322","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - A9513","CORRECTIONS - CORRECTIONS ICE INMATE - A9513","CORRECTIONS - CORRECTIONS ICE INMATE - A9513 - DELETED 2077","CORRECTIONS","CORRECTIONS ICE INMATE","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,304.95999999999998,154.44,456.36,107.25]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - Q9963","CORRECTIONS - CORRECTIONS ICE INMATE - Q9963","CORRECTIONS - CORRECTIONS ICE INMATE - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS ICE INMATE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 45380","CORRECTIONS - CORRECTIONS NAPHCARE - 45380","CORRECTIONS - CORRECTIONS NAPHCARE - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","CORRECTIONS","CORRECTIONS NAPHCARE","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1391.24,420.34,2575,643.75]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 90832","CORRECTIONS - CORRECTIONS NASHUA - 90832","CORRECTIONS - CORRECTIONS NASHUA - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","CORRECTIONS","CORRECTIONS NASHUA","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 73721","CORRECTIONS - CORRECTIONS NORFOLK - 73721","CORRECTIONS - CORRECTIONS NORFOLK - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","CORRECTIONS","CORRECTIONS NORFOLK","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,288.89,254.07,4304.3999999999996,1266]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - Q9967","CORRECTIONS - CORRECTIONS NORFOLK - Q9967","CORRECTIONS - CORRECTIONS NORFOLK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS NORFOLK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 85027","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - 85027","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - 85027 - CHG COMPLETE CBC","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.79,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 70450","CORRECTIONS - CORRECTIONS PLYMOUTH - 70450","CORRECTIONS - CORRECTIONS PLYMOUTH - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 99213","CORRECTIONS - CORRECTIONS PLYMOUTH - 99213","CORRECTIONS - CORRECTIONS PLYMOUTH - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,69.23,23.27,456.36,69.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 72148","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 72148","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 72148 - CHG MRI, LUMBAR SPINE","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,288.89,254.07,3938.05,1158.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 93452","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 93452","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 66821","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - 66821","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - 66821 - PR DISCISSION,2ND CATARACT,LASER","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,717.92,420.34,2389.35,702.75]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - A9517","CORRECTIONS - ZZZCORRECTIONS BAY STATE - A9517","CORRECTIONS - ZZZCORRECTIONS BAY STATE - A9517 - PR I131 IODIDE CAP, RX","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.41,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 64483","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - 64483","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1074.5899999999999,420.34,1879.97,386.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 85730","CORRECTIONS - ZZZCORRECTIONS BRADSTON - 85730","CORRECTIONS - ZZZCORRECTIONS BRADSTON - 85730 - CHG THROMBOPLAS TIME PARTIAL","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 77065","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - 77065","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 76700","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - 76700","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - Q9967","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 76700","CORRECTIONS - ZZZCORRECTIONS CONCORD - 76700","CORRECTIONS - ZZZCORRECTIONS CONCORD - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","CORRECTIONS","ZZZCORRECTIONS CONCORD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 99212","CORRECTIONS - ZZZCORRECTIONS CONCORD - 99212","CORRECTIONS - ZZZCORRECTIONS CONCORD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","CORRECTIONS","ZZZCORRECTIONS CONCORD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,37.01,23.27,456.36,36.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 81000","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - 81000","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - Q9963","CORRECTIONS - ZZZCORRECTIONS GARDNER - Q9963","CORRECTIONS - ZZZCORRECTIONS GARDNER - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 45378","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - 45378","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 99215","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - 99215","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,155.85,23.27,595,148.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - A9579","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - A9579","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 85027","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - 85027","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - 85027 - CHG COMPLETE CBC","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.79,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 80076","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - 80076","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - 80076 - CHG HEPATIC FUNCTION PANEL","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.58,7.21,456.36,40.75]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 72193","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - 72193","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - 72193 - CHG CT SCAN OF PELVIS CONTRAST","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,216.61,190.5,2584,760]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - Q9967","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 43235","CORRECTIONS - ZZZCORRECTIONS NORFOLK - 43235","CORRECTIONS - ZZZCORRECTIONS NORFOLK - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 99204","CORRECTIONS - ZZZCORRECTIONS NORFOLK - 99204","CORRECTIONS - ZZZCORRECTIONS NORFOLK - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,155.85,23.27,705,176.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 76830","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - 76830","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - Q9967","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 43235","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - 43235","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 99214","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - 99214","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,102.14,23.27,456.36,105.5]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9966","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - Q9966","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - Q9966 - LOCM 200-299MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 84153","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - 84153","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 85610","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - 85610","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - 85610 - CHG PROTHROMBIN TIME","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.5,3.58,456.36,7.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - Q9967","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - Q9963","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - Q9963","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["FALLON - FALLON HMO STANDARD - CPT - 45378","FALLON - FALLON HMO STANDARD - 45378","FALLON - FALLON HMO STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","FALLON","FALLON HMO STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077,395.43,2154,538.5]
["FALLON - FALLON POS STANDARD - CPT - 85025","FALLON - FALLON POS STANDARD - 85025","FALLON - FALLON POS STANDARD - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","FALLON","FALLON POS STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,27.5,6.85,456.36,13.75]
["FALLON - FALLON POS STANDARD - CPT - 90846","FALLON - FALLON POS STANDARD - 90846","FALLON - FALLON POS STANDARD - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","FALLON","FALLON POS STANDARD","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,154,30.9,456.36,77]
["FALLON - FALLON PPO STANDARD - CPT - Q9963","FALLON - FALLON PPO STANDARD - Q9963","FALLON - FALLON PPO STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","FALLON","FALLON PPO STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.5,0.22,456.36,0.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 COMMONHLTH - CPT - 80069","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 COMMONHLTH - 80069","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 COMMONHLTH - 80069 - CHG RENAL FUNCTION PANEL","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 COMMONHLTH","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST - CPT - 81001","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST - 81001","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 80061","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - 80061","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - 80061 - CHG LIPID PANEL","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25]
["FALLON MEDICAID MANAGED - FALLON MCD MNG CARE PLUS - CPT - 81001","FALLON MEDICAID MANAGED - FALLON MCD MNG CARE PLUS - 81001","FALLON MEDICAID MANAGED - FALLON MCD MNG CARE PLUS - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","FALLON MEDICAID MANAGED","FALLON MCD MNG CARE PLUS","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 99212","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - 99212","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 62323","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - 62323","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 81001","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - 81001","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["FALLON SCO - FALLON SCO HMO - CPT - 80061","FALLON SCO - FALLON SCO HMO - 80061","FALLON SCO - FALLON SCO HMO - 80061 - CHG LIPID PANEL","FALLON SCO","FALLON SCO HMO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 99205","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - 99205","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 99205","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - 99205","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 72148","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - 72148","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - 72148 - CHG MRI, LUMBAR SPINE","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,451.66,254.07,3938.05,1158.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 43235","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - 43235","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1871.88,420.34,1871.88,376.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 43235","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - 43235","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1871.88,420.34,1871.88,376.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 45378","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - 45378","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 99212","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - 99212","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 80076","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - 80076","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - 80076 - CHG HEPATIC FUNCTION PANEL","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,22.32,7.21,456.36,40.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - P9047","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - P9047","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,52.45,50.13,456.36,45]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 45378","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - 45378","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 45385","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - 45385","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 81002","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - 81002","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["HSN - HSN STANDARD - CPT - 55700","HSN - HSN STANDARD - 55700","HSN - HSN STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","HSN","HSN STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,456.36,420.34,3848.68,587]
["HSN - HSN STANDARD - CPT - 99215","HSN - HSN STANDARD - 99215","HSN - HSN STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","HSN","HSN STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,456.36,23.27,595,148.75]
["HSN - HSN TEMPORARY - CPT - A9500","HSN - HSN TEMPORARY - A9500","HSN - HSN TEMPORARY - A9500 - PR TC99M SESTAMIBI","HSN","HSN TEMPORARY","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,456.36,128.52000000000001,456.36,89.25]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 84443","HSN BAD DEBT - HSN BAD DEBT - 84443","HSN BAD DEBT - HSN BAD DEBT - 84443 - CHG ASSAY THYROID STIM HORMONE","HSN BAD DEBT","HSN BAD DEBT","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,456.36,14.82,456.36,28.5]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 90846","HSN CONFIDENTIAL - HSN CONFIDENTIAL - 90846","HSN CONFIDENTIAL - HSN CONFIDENTIAL - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,456.36,30.9,456.36,77]
["HSN DENTAL - HSN DENTAL - CPT - 62322","HSN DENTAL - HSN DENTAL - 62322","HSN DENTAL - HSN DENTAL - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","HSN DENTAL","HSN DENTAL","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,456.36,82.95,1426,356.5]
["HSN DENTAL - HSN DENTAL - CPT - A9552","HSN DENTAL - HSN DENTAL - A9552","HSN DENTAL - HSN DENTAL - A9552 - PR F18 FDG","HSN DENTAL","HSN DENTAL","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,456.36,365.4,1015,253.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 62322","HSN PARTIAL - HSN PARTIAL TEMPORARY - 62322","HSN PARTIAL - HSN PARTIAL TEMPORARY - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,456.36,82.95,1426,356.5]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 80069","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - 80069","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - 80069 - CHG RENAL FUNCTION PANEL","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO - MASS GEN BRIG HLTH PLAN ACO MYCARE FAM - CPT - 81000","MASS GENERAL BRIGHAM HEALTH PLAN ACO - MASS GEN BRIG HLTH PLAN ACO MYCARE FAM - 81000","MASS GENERAL BRIGHAM HEALTH PLAN ACO - MASS GEN BRIG HLTH PLAN ACO MYCARE FAM - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN ACO","MASS GEN BRIG HLTH PLAN ACO MYCARE FAM","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 90847","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - 90847","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,204.44,30.9,456.36,90.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 80055","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - 80055","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - 80055 - CHG OBSTETRIC PANEL","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,146.43,18.32,456.36,65]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - A9513","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - A9513","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - A9513 - DELETED 2077","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,241.61,154.44,456.36,107.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - CPT - 80053","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - 80053","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG COMMON","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC - CPT - 81003","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC - 81003","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 2 - CPT - 81001","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 2 - 81001","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 2 - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 2","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.22,2.8,456.36,6]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 81003","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - 81003","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,9.57,1.63,456.36,4.25]
["MEDICAID - MEDICAID FAMILY ASSIST - CPT - 80069","MEDICAID - MEDICAID FAMILY ASSIST - 80069","MEDICAID - MEDICAID FAMILY ASSIST - 80069 - CHG RENAL FUNCTION PANEL","MEDICAID","MEDICAID FAMILY ASSIST","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75]
["MEDICAID - MEDICAID STANDARD - CPT - 85730","MEDICAID - MEDICAID STANDARD - 85730","MEDICAID - MEDICAID STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","MEDICAID","MEDICAID STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["MEDICAID ACO - ZZZMEDICAID ACO COMM COMMONHLTH - CPT - 85610","MEDICAID ACO - ZZZMEDICAID ACO COMM COMMONHLTH - 85610","MEDICAID ACO - ZZZMEDICAID ACO COMM COMMONHLTH - 85610 - CHG PROTHROMBIN TIME","MEDICAID ACO","ZZZMEDICAID ACO COMM COMMONHLTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - CPT - 80053","MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - 80053","MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD FAM ASSIS - CPT - 84153","MEDICAID ACO - ZZZMEDICAID ACO STEWRD FAM ASSIS - 84153","MEDICAID ACO - ZZZMEDICAID ACO STEWRD FAM ASSIS - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","MEDICAID ACO","ZZZMEDICAID ACO STEWRD FAM ASSIS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.22,13.26,456.36,31.25]
["MEDICAID MANAGED CARE - MCD MNG CARE COMMONHEALTH - CPT - 80053","MEDICAID MANAGED CARE - MCD MNG CARE COMMONHEALTH - 80053","MEDICAID MANAGED CARE - MCD MNG CARE COMMONHEALTH - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","MEDICAID MANAGED CARE","MCD MNG CARE COMMONHEALTH","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["MEDICAID MANAGED CARE - MCD MNG CARE FAMILY ASSIST - CPT - 85610","MEDICAID MANAGED CARE - MCD MNG CARE FAMILY ASSIST - 85610","MEDICAID MANAGED CARE - MCD MNG CARE FAMILY ASSIST - 85610 - CHG PROTHROMBIN TIME","MEDICAID MANAGED CARE","MCD MNG CARE FAMILY ASSIST","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["MEDICARE - MEDICARE A&B - CPT - Q9967","MEDICARE - MEDICARE A&B - Q9967","MEDICARE - MEDICARE A&B - Q9967 - LOCM 300-399MG/ML IODINE,1ML","MEDICARE","MEDICARE A&B","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["MEDICARE - MEDICARE PART A ONLY - CPT - 95810","MEDICARE - MEDICARE PART A ONLY - 95810","MEDICARE - MEDICARE PART A ONLY - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","MEDICARE","MEDICARE PART A ONLY","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - 99204","MEDICARE - MEDICARE PART B ONLY - 99204","MEDICARE - MEDICARE PART B ONLY - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","MEDICARE","MEDICARE PART B ONLY","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 73721","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - 73721","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 80053","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - 80053","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 90832","OXFORD HEALTH - OXFORD HEALTH STANDARD - 90832","OXFORD HEALTH - OXFORD HEALTH STANDARD - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,168,21.97,456.36,42]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 95810","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - 95810","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2595.64,420.34,3344.75,983.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 99204","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - 99204","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,178.11,23.27,705,176.25]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 85025","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - 85025","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,9.32,6.85,456.36,13.75]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 81000","TRICARE EAST - TRICARE EAST PRIME (HMO) - 81000","TRICARE EAST - TRICARE EAST PRIME (HMO) - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.84,2.89,456.36,6]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 99203","TRICARE EAST - TRICARE EAST SELECT - 99203","TRICARE EAST - TRICARE EAST SELECT - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","TRICARE EAST","TRICARE EAST SELECT","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,137.06,23.27,456.36,103.75]
["TRICARE EAST - TRICARE EAST SELECT - CPT - A9500","TRICARE EAST - TRICARE EAST SELECT - A9500","TRICARE EAST - TRICARE EAST SELECT - A9500 - PR TC99M SESTAMIBI","TRICARE EAST","TRICARE EAST SELECT","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - A9517","TRICARE FOR LIFE - TRICARE FOR LIFE - A9517","TRICARE FOR LIFE - TRICARE FOR LIFE - A9517 - PR I131 IODIDE CAP, RX","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.54,20.12,456.36,130.75]
["TUFTS - TUFTS CARELINK - CPT - 93452","TUFTS - TUFTS CARELINK - 93452","TUFTS - TUFTS CARELINK - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","TUFTS","TUFTS CARELINK","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,6358,420.34,6358,1589.5]
["TUFTS - TUFTS POS - CPT - 43239","TUFTS - TUFTS POS - 43239","TUFTS - TUFTS POS - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","TUFTS","TUFTS POS","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1505.24,420.34,1871.88,428]
["TUFTS - TUFTS PPO - CPT - 43239","TUFTS - TUFTS PPO - 43239","TUFTS - TUFTS PPO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","TUFTS","TUFTS PPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1505.24,420.34,1871.88,428]
["TUFTS - TUFTS PPO - CPT - 81003","TUFTS - TUFTS PPO - 81003","TUFTS - TUFTS PPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","TUFTS","TUFTS PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,6.14,1.63,456.36,4.25]
["TUFTS - TUFTS SELECT - CPT - 99213","TUFTS - TUFTS SELECT - 99213","TUFTS - TUFTS SELECT - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","TUFTS","TUFTS SELECT","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,23.27,23.27,456.36,69.25]
["TUFTS - TUFTS SPIRIT - CPT - 81000","TUFTS - TUFTS SPIRIT - 81000","TUFTS - TUFTS SPIRIT - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","TUFTS","TUFTS SPIRIT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 77066","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - 77066","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,420.34,131.5,924,231]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 45391","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - 45391","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,420.34,420.34,2924,731]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 99386","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - 99386","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - 99386 - PR PREVENTIVE VISIT,NEW,40-64","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,420.34,23.27,640,160]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - A9581","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - A9581","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - A9581 - PR GADOXETATE DISODIUM INJ","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,420.34,15.3,456.36,24.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 81003","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - 81003","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,3.12,1.63,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 81000","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - 81000","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.8099999999999996,2.89,456.36,6]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 45380","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - 45380","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,420.34,420.34,2575,643.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 99215","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - 99215","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,420.34,23.27,595,148.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 76700","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - 76700","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,170.93,111.92,961.35,282.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 84443","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - 84443","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - 84443 - CHG ASSAY THYROID STIM HORMONE","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,20.079999999999998,14.82,456.36,28.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 62323","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - 62323","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1075.18,420.34,1505.24,371.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - J3301","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3301","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - A9579","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - A9579","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,420.34,1.08,456.36,0.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 90715","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - 90715","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - 90715 - PR TDAP VACCINE >7 YO, IM","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 99215","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - 99215","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,420.34,23.27,595,148.75]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 62323","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - 62323","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 76700","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - 76700","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - A9579","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - A9579","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 90662","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - 90662","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 99214","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - 99214","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 73721","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - 73721","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - Q9967","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - Q9967","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS - CPT - 85025","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS - 85025","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH CARE PLUS - CPT - 80076","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH CARE PLUS - 80076","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH CARE PLUS - 80076 - CHG HEPATIC FUNCTION PANEL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH CARE PLUS","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS - CPT - 81002","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS - 81002","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA COMMONHLTH - CPT - 81002","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA COMMONHLTH - 81002","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA COMMONHLTH - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA COMMONHLTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY STANDARD - CPT - 80053","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY STANDARD - 80053","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY STANDARD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO STANDARD - CPT - 80076","TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO STANDARD - 80076","TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO STANDARD - 80076 - CHG HEPATIC FUNCTION PANEL","TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["UBH HPHC - UBH HPHC - CPT - 99214","UBH HPHC - UBH HPHC - 99214","UBH HPHC - UBH HPHC - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","UBH HPHC","UBH HPHC","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["UNICARE - UNICARE STANDARD - CPT - 81002","UNICARE - UNICARE STANDARD - 81002","UNICARE - UNICARE STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","UNICARE","UNICARE STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,4.5,2.34,456.36,4.25]
["UNITED - UNITED DEFINITY HRA - CPT - 99213","UNITED - UNITED DEFINITY HRA - 99213","UNITED - UNITED DEFINITY HRA - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","UNITED","UNITED DEFINITY HRA","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["UNITED - UNITED HP SHIP - CPT - 55700","UNITED - UNITED HP SHIP - 55700","UNITED - UNITED HP SHIP - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","UNITED","UNITED HP SHIP","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,3848.68,420.34,3848.68,587]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 55700","UNITED - UNITED HP STUDENT HEALTH - 55700","UNITED - UNITED HP STUDENT HEALTH - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","UNITED","UNITED HP STUDENT HEALTH","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,3848.68,420.34,3848.68,587]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 99212","UNITED - UNITED HP STUDENT HEALTH - 99212","UNITED - UNITED HP STUDENT HEALTH - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","UNITED","UNITED HP STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75]
["UNITED - UNITED PASSPORT CONNECT - CPT - 80069","UNITED - UNITED PASSPORT CONNECT - 80069","UNITED - UNITED PASSPORT CONNECT - 80069 - CHG RENAL FUNCTION PANEL","UNITED","UNITED PASSPORT CONNECT","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,26.35,7.66,456.36,48.75]
["UNITED - UNITED PASSPORT CONNECT - CPT - 85027","UNITED - UNITED PASSPORT CONNECT - 85027","UNITED - UNITED PASSPORT CONNECT - 85027 - CHG COMPLETE CBC","UNITED","UNITED PASSPORT CONNECT","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,17.649999999999999,5.71,456.36,11.25]
["UNITED - UNITED STANDARD - CPT - 90715","UNITED - UNITED STANDARD - 90715","UNITED - UNITED STANDARD - 90715 - PR TDAP VACCINE >7 YO, IM","UNITED","UNITED STANDARD","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 99214","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - 99214","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 99215","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - 99215","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 81003","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - 81003","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 84443","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - 84443","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - 84443 - CHG ASSAY THYROID STIM HORMONE","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 90832","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - 90832","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - A9579","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - A9579","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - J1030","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J1030","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 90715","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - 90715","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - 90715 - PR TDAP VACCINE >7 YO, IM","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 90832","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - 90832","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,67.2,21.97,456.36,42]
["WELLCARE - WELLCARE PPO - CPT - 66821","WELLCARE - WELLCARE PPO - 66821","WELLCARE - WELLCARE PPO - 66821 - PR DISCISSION,2ND CATARACT,LASER","WELLCARE","WELLCARE PPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,678.76,420.34,2389.35,702.75]
["WELLCARE - WELLCARE PPO - CPT - 81003","WELLCARE - WELLCARE PPO - 81003","WELLCARE - WELLCARE PPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","WELLCARE","WELLCARE PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.34,1.63,456.36,4.25]
["WELLCARE - WELLCARE STANDARD - CPT - Q9963","WELLCARE - WELLCARE STANDARD - Q9963","WELLCARE - WELLCARE STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","WELLCARE","WELLCARE STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["WELLSENSE - WELLSENSE CLARITY GOLD - CPT - 85730","WELLSENSE - WELLSENSE CLARITY GOLD - 85730","WELLSENSE - WELLSENSE CLARITY GOLD - 85730 - CHG THROMBOPLAS TIME PARTIAL","WELLSENSE","WELLSENSE CLARITY GOLD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.36,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 85730","WELLSENSE - WELLSENSE CLARITY PLATINUM - 85730","WELLSENSE - WELLSENSE CLARITY PLATINUM - 85730 - CHG THROMBOPLAS TIME PARTIAL","WELLSENSE","WELLSENSE CLARITY PLATINUM","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.36,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - CPT - 84153","WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - 84153","WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO EAST BOSTON","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.22,13.26,456.36,31.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 85025","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - 85025","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM COMMONHLTH","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 81000","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - 81000","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY CARE PLUS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 85610","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - 85610","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - 85610 - CHG PROTHROMBIN TIME","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 81002","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - 81002","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO CARE PLUS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 80055","WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - 80055","WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - 80055 - CHG OBSTETRIC PANEL","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO COMMONHEALTH","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 62322","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - 62322","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,513.36,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 45391","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - 45391","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - A9555","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - A9555","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - A9555 - PR RB82 RUBIDIUM","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 85610","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - 85610","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - 85610 - CHG PROTHROMBIN TIME","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 45385","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - 45385","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1299.3,420.34,2929.62,760]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 70553","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - 70553","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - 70553 - CHG MRI BRAIN COMBO","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,2956.33,398.75,5879.45,1729.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 84443","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - 84443","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - 84443 - CHG ASSAY THYROID STIM HORMONE","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,23.47,14.82,456.36,28.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - A9581","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - A9581","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - A9581 - PR GADOXETATE DISODIUM INJ","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,42.31,15.3,456.36,24.75]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 81002","WORKERS COMP - WORKERS COMP CITY OF BOSTON - 81002","WORKERS COMP - WORKERS COMP CITY OF BOSTON - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.57,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - Q9967","WORKERS COMP - WORKERS COMP CITY OF BOSTON - Q9967","WORKERS COMP - WORKERS COMP CITY OF BOSTON - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 45391","WORKERS COMP - WORKERS COMP COVE RISK - 45391","WORKERS COMP - WORKERS COMP COVE RISK - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","WORKERS COMP","WORKERS COMP COVE RISK","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1249.72,420.34,2924,731]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 99386","WORKERS COMP - WORKERS COMP COVE RISK - 99386","WORKERS COMP - WORKERS COMP COVE RISK - 99386 - PR PREVENTIVE VISIT,NEW,40-64","WORKERS COMP","WORKERS COMP COVE RISK","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,273.54000000000002,23.27,640,160]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - A9579","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - A9579","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - A9579 - GAD-BASE MR CONTRAST NOS,1ML","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.14,1.57,456.36,1.25]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 81003","WORKERS COMP - WORKERS COMP GUARD INSURANCE - 81003","WORKERS COMP - WORKERS COMP GUARD INSURANCE - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,3.14,1.63,456.36,4.25]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 62322","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - 62322","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,609.47,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 99205","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - 99205","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,188.86,23.27,899,224.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - A9513","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - A9513","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - A9513 - DELETED 2077","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,183.35,154.44,456.36,107.25]
["WORKERS COMP - WORKERS COMP MBTA - CPT - A9513","WORKERS COMP - WORKERS COMP MBTA - A9513","WORKERS COMP - WORKERS COMP MBTA - A9513 - DELETED 2077","WORKERS COMP","WORKERS COMP MBTA","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,183.35,154.44,456.36,107.25]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 97110","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - 97110","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - 97110 - PR THERAPEUTIC EXERCISES","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,23.1,23.1,456.36,62.25]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 43235","WORKERS COMP - WORKERS COMP STANDARD - 43235","WORKERS COMP - WORKERS COMP STANDARD - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","WORKERS COMP","WORKERS COMP STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,643.24,420.34,1871.88,376.25]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 99213","WORKERS COMP - WORKERS COMP STANDARD - 99213","WORKERS COMP - WORKERS COMP STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","WORKERS COMP","WORKERS COMP STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,65.91,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 99212","WORKERS COMP - WORKERS COMP THE HARTFORD - 99212","WORKERS COMP - WORKERS COMP THE HARTFORD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,41.58,23.27,456.36,36.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 99212","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - 99212","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,41.58,23.27,456.36,36.75]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 90715","WORKERS COMP - ZZZWORKERS COMP AIG - 90715","WORKERS COMP - ZZZWORKERS COMP AIG - 90715 - PR TDAP VACCINE >7 YO, IM","WORKERS COMP","ZZZWORKERS COMP AIG","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,76.930000000000007,39.75,456.36,45]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 45378","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - 45378","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 45378","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - 45378","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 80076","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - 80076","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - 80076 - CHG HEPATIC FUNCTION PANEL","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,11.42,7.21,456.36,40.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 76830","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - 76830","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,131.47999999999999,113.99,873.8,257]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 81000","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - 81000","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.43,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 80048","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - 80048","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,11.83,7.46,456.36,41.75]
["ZZZAETNA - ZZZAETNA HMO - CPT - Q9967","ZZZAETNA - ZZZAETNA HMO - Q9967","ZZZAETNA - ZZZAETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZAETNA","ZZZAETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 81002","ZZZAETNA - ZZZAETNA MCR SUPP - 81002","ZZZAETNA - ZZZAETNA MCR SUPP - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","ZZZAETNA","ZZZAETNA MCR SUPP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 77065","ZZZAETNA - ZZZAETNA POS - 77065","ZZZAETNA - ZZZAETNA POS - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","ZZZAETNA","ZZZAETNA POS","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 77065","ZZZAETNA - ZZZAETNA PPO-EPO - 77065","ZZZAETNA - ZZZAETNA PPO-EPO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","ZZZAETNA","ZZZAETNA PPO-EPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 76700","ZZZAETNA - ZZZAETNA STUDENT HEALTH - 76700","ZZZAETNA - ZZZAETNA STUDENT HEALTH - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99204","ZZZAETNA - ZZZAETNA STUDENT HEALTH - 99204","ZZZAETNA - ZZZAETNA STUDENT HEALTH - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99204","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - 99204","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 62322","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - 62322","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 80061","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - 80061","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - 80061 - CHG LIPID PANEL","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,14.06,11.81,456.36,32.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - Q9967","ZZZCIGNA - CIGNA LOCALPLUS - Q9967","ZZZCIGNA - CIGNA LOCALPLUS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZCIGNA","CIGNA LOCALPLUS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.85,0.12,456.36,0.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 55700","ZZZCIGNA - ZZZCIGNA CARELINK - 55700","ZZZCIGNA - ZZZCIGNA CARELINK - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1505.24,420.34,3848.68,587]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99203","ZZZCIGNA - ZZZCIGNA STANDARD - 99203","ZZZCIGNA - ZZZCIGNA STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","ZZZCIGNA","ZZZCIGNA STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,352.75,23.27,456.36,103.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 70553","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - 70553","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - 70553 - CHG MRI BRAIN COMBO","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,2956.33,398.75,5879.45,1729.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 77065","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - 77065","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - Q9967","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - Q9967","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 45378","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - 45378","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99205","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - 99205","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 80055","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - 80055","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - 80055 - CHG OBSTETRIC PANEL","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,130.57,18.32,456.36,65]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - P9047","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - P9047","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,52.45,50.13,456.36,45]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - Q9967","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - Q9967","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 93452","ZZZUNITED - ZZZUNITED DEFINITY HRA - 93452","ZZZUNITED - ZZZUNITED DEFINITY HRA - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 84443","ZZZUNITED - ZZZUNITED HP SHIP - 84443","ZZZUNITED - ZZZUNITED HP SHIP - 84443 - CHG ASSAY THYROID STIM HORMONE","ZZZUNITED","ZZZUNITED HP SHIP","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,51,14.82,456.36,28.5]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 76830","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 76830","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,220.4,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - Q9967","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76830","ZZZUNITED - ZZZUNITED STANDARD - 76830","ZZZUNITED - ZZZUNITED STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZUNITED","ZZZUNITED STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,272.94,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99203","ZZZUNITED - ZZZUNITED STANDARD - 99203","ZZZUNITED - ZZZUNITED STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,328.17,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J1170","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J1170 - PR HYDROMORPHONE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J2001","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J2001 - PR LIDOCAINE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J9041","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J9041","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J9041 - PR INJ., VELCADE 0.1 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J0690","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J2001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J2001 - PR LIDOCAINE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J2704","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J2704 - PR INJ, PROPFOL, 10 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0688","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J0688","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J1580","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J1580 - PR GARAMYCIN GENTAMICIN INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,10.130000000000001,3.65,456.36,2.5299999999999998]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J2310","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q5114","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q5114 - PR INJ OGIVRI 10 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0690","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J0690","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1953","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J1953","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J1953 - PR LEVETIRACETAM INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2310","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J2310","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32]
["AETNA - AETNA HMO - HCPCS - J0690","AETNA - AETNA HMO - J0690","AETNA - AETNA HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,6.87,4.32,456.36,3.25]
["AETNA - AETNA HMO - HCPCS - J1580","AETNA - AETNA HMO - J1580","AETNA - AETNA HMO - J1580 - PR GARAMYCIN GENTAMICIN INJ","AETNA","AETNA HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,6.01,4.09,456.36,2.84]
["AETNA - AETNA HMO - HCPCS - J2310","AETNA - AETNA HMO - J2310","AETNA - AETNA HMO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","AETNA","AETNA HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,57.81,15.14,456.36,27.32]
["AETNA - AETNA HMO - HCPCS - J3490","AETNA - AETNA HMO - J3490","AETNA - AETNA HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,0.6,0.41,456.36,0.28000000000000003]
["AETNA - AETNA MCR SUPP - HCPCS - J0690","AETNA - AETNA MCR SUPP - J0690","AETNA - AETNA MCR SUPP - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA MCR SUPP","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.72,1.17,456.36,0.81]
["AETNA - AETNA MCR SUPP - HCPCS - J1580","AETNA - AETNA MCR SUPP - J1580","AETNA - AETNA MCR SUPP - J1580 - PR GARAMYCIN GENTAMICIN INJ","AETNA","AETNA MCR SUPP","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,195.44,2.78,456.36,92.37]
["AETNA - AETNA MCR SUPP - HCPCS - J2310","AETNA - AETNA MCR SUPP - J2310","AETNA - AETNA MCR SUPP - J2310 - PR INJ NALOXONE HYDROCHLORIDE","AETNA","AETNA MCR SUPP","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,2.54,1.73,456.36,1.2]
["AETNA - AETNA MCR SUPP - HCPCS - Q0249","AETNA - AETNA MCR SUPP - Q0249","AETNA - AETNA MCR SUPP - Q0249 - TOCILIZUMAB FOR COVID-19","AETNA","AETNA MCR SUPP","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,4.76,3.24,456.36,2.25]
["AETNA - AETNA POS - HCPCS - J0690","AETNA - AETNA POS - J0690","AETNA - AETNA POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,6.87,4.32,456.36,3.25]
["AETNA - AETNA POS - HCPCS - J1580","AETNA - AETNA POS - J1580","AETNA - AETNA POS - J1580 - PR GARAMYCIN GENTAMICIN INJ","AETNA","AETNA POS","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,4.62,0.79,456.36,2.19]
["AETNA - AETNA POS - HCPCS - J3490","AETNA - AETNA POS - J3490","AETNA - AETNA POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,9.4,6.4,456.36,4.4400000000000004]
["AETNA - AETNA PPO EPO - HCPCS - J0690","AETNA - AETNA PPO EPO - J0690","AETNA - AETNA PPO EPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA PPO EPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.72,1.17,456.36,0.81]
["AETNA - AETNA PPO EPO - HCPCS - J1170","AETNA - AETNA PPO EPO - J1170","AETNA - AETNA PPO EPO - J1170 - PR HYDROMORPHONE INJECTION","AETNA","AETNA PPO EPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.03,0.7,456.36,0.49]
["AETNA - AETNA PPO EPO - HCPCS - J2001","AETNA - AETNA PPO EPO - J2001","AETNA - AETNA PPO EPO - J2001 - PR LIDOCAINE INJECTION","AETNA","AETNA PPO EPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.36,0.06,456.36,0.17]
["AETNA - AETNA PPO EPO - HCPCS - J3490","AETNA - AETNA PPO EPO - J3490","AETNA - AETNA PPO EPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA PPO EPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,0.6,0.41,456.36,0.28000000000000003]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J0137","AETNA - AETNA STUDENT HEALTH - J0137","AETNA - AETNA STUDENT HEALTH - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","AETNA","AETNA STUDENT HEALTH","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,22.55,5.0999999999999996,456.36,10.66]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J1580","AETNA - AETNA STUDENT HEALTH - J1580","AETNA - AETNA STUDENT HEALTH - J1580 - PR GARAMYCIN GENTAMICIN INJ","AETNA","AETNA STUDENT HEALTH","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,1.1599999999999999,0.79,456.36,0.55000000000000004]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2001","AETNA - AETNA STUDENT HEALTH - J2001","AETNA - AETNA STUDENT HEALTH - J2001 - PR LIDOCAINE INJECTION","AETNA","AETNA STUDENT HEALTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.51,1.03,456.36,0.71]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J3490","AETNA - AETNA STUDENT HEALTH - J3490","AETNA - AETNA STUDENT HEALTH - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA STUDENT HEALTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,0.6,0.41,456.36,0.28000000000000003]
["AETNA - AETNA STUDENT HEALTH - HCPCS - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2001","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J2001","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J2001 - PR LIDOCAINE INJECTION","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2704","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J2704","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83]
["BCBS - BCBS HMO - HCPCS - J0690","BCBS - BCBS HMO - J0690","BCBS - BCBS HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["BCBS - BCBS HMO - HCPCS - J1170","BCBS - BCBS HMO - J1170","BCBS - BCBS HMO - J1170 - PR HYDROMORPHONE INJECTION","BCBS","BCBS HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13]
["BCBS - BCBS HMO - HCPCS - J2001","BCBS - BCBS HMO - J2001","BCBS - BCBS HMO - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.84,1.03,456.36,0.71]
["BCBS - BCBS HMO - HCPCS - J2919","BCBS - BCBS HMO - J2919","BCBS - BCBS HMO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","BCBS","BCBS HMO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,145.47999999999999,52.37,456.36,36.369999999999997]
["BCBS - BCBS INDEMNITY - HCPCS - J0137","BCBS - BCBS INDEMNITY - J0137","BCBS - BCBS INDEMNITY - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","BCBS","BCBS INDEMNITY","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,7,5.0999999999999996,456.36,10.66]
["BCBS - BCBS INDEMNITY - HCPCS - J1561","BCBS - BCBS INDEMNITY - J1561","BCBS - BCBS INDEMNITY - J1561 - PR GAMUNEX-C/GAMMAKED","BCBS","BCBS INDEMNITY","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,1955.2,417.75,7890.89,1160.43]
["BCBS - BCBS INDEMNITY - HCPCS - J2001","BCBS - BCBS INDEMNITY - J2001","BCBS - BCBS INDEMNITY - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS INDEMNITY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,14.19,7.91,456.36,5.49]
["BCBS - BCBS INDEMNITY - HCPCS - J3490","BCBS - BCBS INDEMNITY - J3490","BCBS - BCBS INDEMNITY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS INDEMNITY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["BCBS - BCBS POS - HCPCS - J1170","BCBS - BCBS POS - J1170","BCBS - BCBS POS - J1170 - PR HYDROMORPHONE INJECTION","BCBS","BCBS POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75]
["BCBS - BCBS POS - HCPCS - J1953","BCBS - BCBS POS - J1953","BCBS - BCBS POS - J1953 - PR LEVETIRACETAM INJECTION","BCBS","BCBS POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88]
["BCBS - BCBS POS - HCPCS - J2704","BCBS - BCBS POS - J2704","BCBS - BCBS POS - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BCBS POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["BCBS - BCBS POS - HCPCS - J7131","BCBS - BCBS POS - J7131","BCBS - BCBS POS - J7131 - PR HYPERTONIC SALINE SOL","BCBS","BCBS POS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,10.26,5.72,456.36,3.97]
["BCBS - BCBS PPO - HCPCS - J0690","BCBS - BCBS PPO - J0690","BCBS - BCBS PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["BCBS - BCBS PPO - HCPCS - J1953","BCBS - BCBS PPO - J1953","BCBS - BCBS PPO - J1953 - PR LEVETIRACETAM INJECTION","BCBS","BCBS PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43]
["BCBS - BCBS PPO - HCPCS - J2704","BCBS - BCBS PPO - J2704","BCBS - BCBS PPO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BCBS PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001]
["BCBS - BCBS PPO - HCPCS - J3490","BCBS - BCBS PPO - J3490","BCBS - BCBS PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["BCBS - BCBS SHIP PPO - HCPCS - J0736","BCBS - BCBS SHIP PPO - J0736","BCBS - BCBS SHIP PPO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","BCBS","BCBS SHIP PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,4.54,3.81,456.36,10.53]
["BCBS - BCBS SHIP PPO - HCPCS - J2310","BCBS - BCBS SHIP PPO - J2310","BCBS - BCBS SHIP PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","BCBS","BCBS SHIP PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["BCBS - BCBS SHIP PPO - HCPCS - J2704","BCBS - BCBS SHIP PPO - J2704","BCBS - BCBS SHIP PPO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BCBS SHIP PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["BCBS - BCBS STANDARD - HCPCS - J0690","BCBS - BCBS STANDARD - J0690","BCBS - BCBS STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["BCBS - BCBS STANDARD - HCPCS - J1953","BCBS - BCBS STANDARD - J1953","BCBS - BCBS STANDARD - J1953 - PR LEVETIRACETAM INJECTION","BCBS","BCBS STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["BCBS - BCBS STANDARD - HCPCS - J2001","BCBS - BCBS STANDARD - J2001","BCBS - BCBS STANDARD - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.5299999999999998,1.41,456.36,0.98]
["BCBS - BCBS STANDARD - HCPCS - J3490","BCBS - BCBS STANDARD - J3490","BCBS - BCBS STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J0690","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J0690","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J1953","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J1953","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J1953 - PR LEVETIRACETAM INJECTION","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2001","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J2001","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J2001 - PR LIDOCAINE INJECTION","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,14.19,7.91,456.36,5.49]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2919","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J2919","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,145.47999999999999,52.37,456.36,36.369999999999997]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - A9576","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - A9576","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - A9576 - INJ PROHANCE MULTIPACK","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J1815","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - J1815","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - J1815 - PR INSULIN INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J2704","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - J2704","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J0690","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J0690","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J1953","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J1953","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J1953 - PR LEVETIRACETAM INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2310","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J2310","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3490","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J3490","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J0736","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J0736","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",14.75,6.81,5.31,456.36,3.69]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J2001 - PR LIDOCAINE INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.84,1.03,456.36,0.71]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2704","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J2704","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J0690","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J0690","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1815","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J1815","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J1815 - PR INSULIN INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J2704","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J2704","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J2704 - PR INJ, PROPFOL, 10 MG","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J2704","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J2704","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J2704 - PR INJ, PROPFOL, 10 MG","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J0736","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J0736","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,2.27,1.9,456.36,1.41]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J1815","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J1815","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J1815 - PR INSULIN INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J2001 - PR LIDOCAINE INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.84,1.03,456.36,0.71]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J3490","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J3490","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",2.8,2.8,1.01,456.36,0.7]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J0688","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J0688","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J1953","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J1953","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J1953 - PR LEVETIRACETAM INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J2001 - PR LIDOCAINE INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.5299999999999998,1.41,456.36,0.98]
["CCA - CCA SCO ONECARE - HCPCS - C9257","CCA - CCA SCO ONECARE - C9257","CCA - CCA SCO ONECARE - C9257 - PR BEVACIZUMAB INJECTION","CCA","CCA SCO ONECARE","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["CCA - CCA SCO ONECARE - HCPCS - J0688","CCA - CCA SCO ONECARE - J0688","CCA - CCA SCO ONECARE - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CCA","CCA SCO ONECARE","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CCA - CCA SCO ONECARE - HCPCS - J2001","CCA - CCA SCO ONECARE - J2001","CCA - CCA SCO ONECARE - J2001 - PR LIDOCAINE INJECTION","CCA","CCA SCO ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["CCA - CCA SCO ONECARE - HCPCS - J2704","CCA - CCA SCO ONECARE - J2704","CCA - CCA SCO ONECARE - J2704 - PR INJ, PROPFOL, 10 MG","CCA","CCA SCO ONECARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["CCA - CCA SCO STANDARD - HCPCS - J0690","CCA - CCA SCO STANDARD - J0690","CCA - CCA SCO STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA","CCA SCO STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CCA - CCA SCO STANDARD - HCPCS - J1815","CCA - CCA SCO STANDARD - J1815","CCA - CCA SCO STANDARD - J1815 - PR INSULIN INJECTION","CCA","CCA SCO STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16]
["CCA - CCA SCO STANDARD - HCPCS - J2001","CCA - CCA SCO STANDARD - J2001","CCA - CCA SCO STANDARD - J2001 - PR LIDOCAINE INJECTION","CCA","CCA SCO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CCA - CCA SCO STANDARD - HCPCS - J3490","CCA - CCA SCO STANDARD - J3490","CCA - CCA SCO STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CCA","CCA SCO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["CCA - ZZZCCA STANDARD - HCPCS - J0690","CCA - ZZZCCA STANDARD - J0690","CCA - ZZZCCA STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA","ZZZCCA STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24]
["CCA - ZZZCCA STANDARD - HCPCS - J1953","CCA - ZZZCCA STANDARD - J1953","CCA - ZZZCCA STANDARD - J1953 - PR LEVETIRACETAM INJECTION","CCA","ZZZCCA STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["CCA - ZZZCCA STANDARD - HCPCS - J3490","CCA - ZZZCCA STANDARD - J3490","CCA - ZZZCCA STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CCA","ZZZCCA STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J0690","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J0690","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J1815","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J1815","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J1815 - PR INSULIN INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J2704","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J2704","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J2704 - PR INJ, PROPFOL, 10 MG","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - Q9967","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - Q9967","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J1170","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J1170","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J1170 - PR HYDROMORPHONE INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2001","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J2001","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J2001 - PR LIDOCAINE INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J7121","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J7121","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - Q5114","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - Q5114","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - Q5114 - PR INJ OGIVRI 10 MG","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,2005.92,420.34,5223.6099999999997,1536.36]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2001","CCA MEDICARE PREFERRED - ZZZCCA - J2001","CCA MEDICARE PREFERRED - ZZZCCA - J2001 - PR LIDOCAINE INJECTION","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2001","CCA MEDICARE PREFERRED - ZZZCCA - J2001","CCA MEDICARE PREFERRED - ZZZCCA - J2001 - PR LIDOCAINE INJECTION","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CIGNA - CIGNA CARELINK - HCPCS - J0583","CIGNA - CIGNA CARELINK - J0583","CIGNA - CIGNA CARELINK - J0583 - PR BIVALIRUDIN","CIGNA","CIGNA CARELINK","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["CIGNA - CIGNA CARELINK - HCPCS - J1815","CIGNA - CIGNA CARELINK - J1815","CIGNA - CIGNA CARELINK - J1815 - PR INSULIN INJECTION","CIGNA","CIGNA CARELINK","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52]
["CIGNA - CIGNA CARELINK - HCPCS - J2001","CIGNA - CIGNA CARELINK - J2001","CIGNA - CIGNA CARELINK - J2001 - PR LIDOCAINE INJECTION","CIGNA","CIGNA CARELINK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17]
["CIGNA - CIGNA CARELINK - HCPCS - J2704","CIGNA - CIGNA CARELINK - J2704","CIGNA - CIGNA CARELINK - J2704 - PR INJ, PROPFOL, 10 MG","CIGNA","CIGNA CARELINK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J0690","CIGNA - CIGNA LOCALPLUS - J0690","CIGNA - CIGNA LOCALPLUS - J0690 - PR CEFAZOLIN SODIUM INJECTION","CIGNA","CIGNA LOCALPLUS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,25.67,3.16,456.36,7.55]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J1170","CIGNA - CIGNA LOCALPLUS - J1170","CIGNA - CIGNA LOCALPLUS - J1170 - PR HYDROMORPHONE INJECTION","CIGNA","CIGNA LOCALPLUS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,2.79,1.18,456.36,0.82]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2001","CIGNA - CIGNA LOCALPLUS - J2001","CIGNA - CIGNA LOCALPLUS - J2001 - PR LIDOCAINE INJECTION","CIGNA","CIGNA LOCALPLUS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.42,1.03,456.36,0.71]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J3490","CIGNA - CIGNA LOCALPLUS - J3490","CIGNA - CIGNA LOCALPLUS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CIGNA","CIGNA LOCALPLUS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,35.299999999999997,14.95,456.36,10.38]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J7131","CIGNA - CIGNA LOCALPLUS - J7131","CIGNA - CIGNA LOCALPLUS - J7131 - PR HYPERTONIC SALINE SOL","CIGNA","CIGNA LOCALPLUS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.1800000000000002,0.92,456.36,0.64]
["CIGNA - CIGNA STANDARD - HCPCS - J1170","CIGNA - CIGNA STANDARD - J1170","CIGNA - CIGNA STANDARD - J1170 - PR HYDROMORPHONE INJECTION","CIGNA","CIGNA STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,30.3,4.76,456.36,8.91]
["CIGNA - CIGNA STANDARD - HCPCS - J2001","CIGNA - CIGNA STANDARD - J2001","CIGNA - CIGNA STANDARD - J2001 - PR LIDOCAINE INJECTION","CIGNA","CIGNA STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.42,1.03,456.36,0.71]
["CIGNA - CIGNA STANDARD - HCPCS - J3490","CIGNA - CIGNA STANDARD - J3490","CIGNA - CIGNA STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CIGNA","CIGNA STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,0.96,0.41,456.36,0.28000000000000003]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J1170","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J1170","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J1953","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J1953","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J3010","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J3010","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J0690","CORRECTIONS - CORRECTIONS BRISTOL - J0690","CORRECTIONS - CORRECTIONS BRISTOL - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J1170","CORRECTIONS - CORRECTIONS BRISTOL - J1170","CORRECTIONS - CORRECTIONS BRISTOL - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2001","CORRECTIONS - CORRECTIONS BRISTOL - J2001","CORRECTIONS - CORRECTIONS BRISTOL - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - Q5114","CORRECTIONS - CORRECTIONS BRISTOL - Q5114","CORRECTIONS - CORRECTIONS BRISTOL - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,2005.92,420.34,5223.6099999999997,1536.36]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J0690","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J0690","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2001","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J2001","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2310","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J2310","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J0690","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J0690","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J1815","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J1815","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J1815 - PR INSULIN INJECTION","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J2001","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J2001","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J3490","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J3490","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",2.8,2.8,1.01,456.36,0.7]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J0690","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J0690","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J1953","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J1953","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2704","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J2704","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J0690","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J0690","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J1170","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J1170","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2704","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J2704","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J0690","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J0690","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1250","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J1250","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2001","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J2001","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J3490","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J3490","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J0137","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J0137","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.61,5.0999999999999996,456.36,10.66]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1170","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J1170","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2001","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J2001","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.4700000000000002,2.4700000000000002,0.89,456.36,0.62]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J0690","CORRECTIONS - CORRECTIONS ICE INMATE - J0690","CORRECTIONS - CORRECTIONS ICE INMATE - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J1170","CORRECTIONS - CORRECTIONS ICE INMATE - J1170","CORRECTIONS - CORRECTIONS ICE INMATE - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2310","CORRECTIONS - CORRECTIONS ICE INMATE - J2310","CORRECTIONS - CORRECTIONS ICE INMATE - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J3490","CORRECTIONS - CORRECTIONS ICE INMATE - J3490","CORRECTIONS - CORRECTIONS ICE INMATE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J0690","CORRECTIONS - CORRECTIONS MIDDLESEX - J0690","CORRECTIONS - CORRECTIONS MIDDLESEX - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1953","CORRECTIONS - CORRECTIONS MIDDLESEX - J1953","CORRECTIONS - CORRECTIONS MIDDLESEX - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2310","CORRECTIONS - CORRECTIONS MIDDLESEX - J2310","CORRECTIONS - CORRECTIONS MIDDLESEX - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J0688","CORRECTIONS - CORRECTIONS NAPHCARE - J0688","CORRECTIONS - CORRECTIONS NAPHCARE - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J0736","CORRECTIONS - CORRECTIONS NAPHCARE - J0736","CORRECTIONS - CORRECTIONS NAPHCARE - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",104.24,59.98,1.9,456.36,26.06]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2001","CORRECTIONS - CORRECTIONS NAPHCARE - J2001","CORRECTIONS - CORRECTIONS NAPHCARE - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2704","CORRECTIONS - CORRECTIONS NAPHCARE - J2704","CORRECTIONS - CORRECTIONS NAPHCARE - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J1170","CORRECTIONS - CORRECTIONS NASHUA - J1170","CORRECTIONS - CORRECTIONS NASHUA - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J1817","CORRECTIONS - CORRECTIONS NASHUA - J1817","CORRECTIONS - CORRECTIONS NASHUA - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2704","CORRECTIONS - CORRECTIONS NASHUA - J2704","CORRECTIONS - CORRECTIONS NASHUA - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J9041","CORRECTIONS - CORRECTIONS NASHUA - J9041","CORRECTIONS - CORRECTIONS NASHUA - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J1580","CORRECTIONS - CORRECTIONS NORFOLK - J1580","CORRECTIONS - CORRECTIONS NORFOLK - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2001","CORRECTIONS - CORRECTIONS NORFOLK - J2001","CORRECTIONS - CORRECTIONS NORFOLK - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J3490","CORRECTIONS - CORRECTIONS NORFOLK - J3490","CORRECTIONS - CORRECTIONS NORFOLK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,7676.82,420.34,7676.82,1919.21]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J0690","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J0690","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,30.2,3.16,456.36,7.55]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J0702","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J0702","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1580","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J1580","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2001","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J2001","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2001","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J2001","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J3490","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J3490","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J3490","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J3490","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J1170","CORRECTIONS - CORRECTIONS PLYMOUTH - J1170","CORRECTIONS - CORRECTIONS PLYMOUTH - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",335.72,335.72,120.86,456.36,83.93]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J1953","CORRECTIONS - CORRECTIONS PLYMOUTH - J1953","CORRECTIONS - CORRECTIONS PLYMOUTH - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2704","CORRECTIONS - CORRECTIONS PLYMOUTH - J2704","CORRECTIONS - CORRECTIONS PLYMOUTH - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J9041","CORRECTIONS - CORRECTIONS PLYMOUTH - J9041","CORRECTIONS - CORRECTIONS PLYMOUTH - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1170","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1170","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1170","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1170","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2001","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J2001","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2704","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J2704","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J3490","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J3490","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J3490","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J3490","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J0690","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J0690","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J1815","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J1815","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J1815 - PR INSULIN INJECTION","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2270","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J2270","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J2270 - PR MORPHINE SULFATE INJECTION","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J3490","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J3490","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J0690","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J2001","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2310","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J2310","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J0702","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J0702","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J1815","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J1815","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J1815 - PR INSULIN INJECTION","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J2704","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J3490","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1580","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J1580","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J2001","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J2704","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS BRADSTON - Q9967","CORRECTIONS - ZZZCORRECTIONS BRADSTON - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J2001","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J2001","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J0688","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J0688","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J1580","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J1580","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,11.37,4.09,456.36,2.84]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J2001","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J3490","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS CEDAR - J0690","CORRECTIONS - ZZZCORRECTIONS CEDAR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS CEDAR - J1953","CORRECTIONS - ZZZCORRECTIONS CEDAR - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS CEDAR - J2001","CORRECTIONS - ZZZCORRECTIONS CEDAR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS CEDAR - J3490","CORRECTIONS - ZZZCORRECTIONS CEDAR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J1815","CORRECTIONS - ZZZCORRECTIONS CONCORD - J1815","CORRECTIONS - ZZZCORRECTIONS CONCORD - J1815 - PR INSULIN INJECTION","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2310","CORRECTIONS - ZZZCORRECTIONS CONCORD - J2310","CORRECTIONS - ZZZCORRECTIONS CONCORD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS CONCORD - J2704","CORRECTIONS - ZZZCORRECTIONS CONCORD - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0736","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J0736","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,2,1.9,456.36,6.97]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J2001","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J2704","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J7131","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J7131","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J7131 - PR HYPERTONIC SALINE SOL","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J1250","CORRECTIONS - ZZZCORRECTIONS GARDNER - J1250","CORRECTIONS - ZZZCORRECTIONS GARDNER - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS GARDNER - J2001","CORRECTIONS - ZZZCORRECTIONS GARDNER - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS GARDNER - J2704","CORRECTIONS - ZZZCORRECTIONS GARDNER - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J0137","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J0137","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.36,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J2001","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J2001","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J3490","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J1580","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J1580","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2310","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J2310","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J3490","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J0736","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J0736","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,4,1.9,456.36,1.57]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J1953","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J2704","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J7121","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J7121","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J1953","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J2704","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - Q5114","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - Q5114","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,2005.92,420.34,5223.6099999999997,1536.36]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J0690","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J2001","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J2704","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - Q5114","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - Q5114","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,2005.92,420.34,5223.6099999999997,1536.36]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J1580","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J1580","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J2001","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J3490","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS NASHUA - J0690","CORRECTIONS - ZZZCORRECTIONS NASHUA - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS NASHUA - J2001","CORRECTIONS - ZZZCORRECTIONS NASHUA - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS NASHUA - J2704","CORRECTIONS - ZZZCORRECTIONS NASHUA - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J0690","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J1815","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J1815","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J1815 - PR INSULIN INJECTION","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J2704","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J3490","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J1815","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J1815","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J1815 - PR INSULIN INJECTION","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J1953","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J7121","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J7121","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,10.66,3.84,456.36,2.67]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J9041","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J9041","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J2001","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J2704","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J3490","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J1170","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",335.72,335.72,120.86,456.36,83.93]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J2001","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J3490","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - Q9967","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,116,0.12,456.36,29]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J2001","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J2001","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",1.64,1.64,0.18,456.36,0.41]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J3490","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",124.59,124.59,14.95,456.36,31.15]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J0690","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2270","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J2270","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J2270 - PR MORPHINE SULFATE INJECTION","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J3590","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J0688","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J0688","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J1817","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J1817","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J2704","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J9041","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J9041","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J1170","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J2001","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J3490","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - Q9967","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J1580","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J1580","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3490","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J3490","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0688","FALLON - FALLON COMMUNITY PLAN - J0688","FALLON - FALLON COMMUNITY PLAN - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","FALLON","FALLON COMMUNITY PLAN","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,6.5,4.32,456.36,3.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1170","FALLON - FALLON COMMUNITY PLAN - J1170","FALLON - FALLON COMMUNITY PLAN - J1170 - PR HYDROMORPHONE INJECTION","FALLON","FALLON COMMUNITY PLAN","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.32,0.23,456.36,0.16]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2001","FALLON - FALLON COMMUNITY PLAN - J2001","FALLON - FALLON COMMUNITY PLAN - J2001 - PR LIDOCAINE INJECTION","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.34,0.06,456.36,0.17]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2919","FALLON - FALLON COMMUNITY PLAN - J2919","FALLON - FALLON COMMUNITY PLAN - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,72.739999999999995,52.37,456.36,36.369999999999997]
["FALLON - FALLON HMO STANDARD - HCPCS - J0583","FALLON - FALLON HMO STANDARD - J0583","FALLON - FALLON HMO STANDARD - J0583 - PR BIVALIRUDIN","FALLON","FALLON HMO STANDARD","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,133.22,55,456.36,66.61]
["FALLON - FALLON HMO STANDARD - HCPCS - J1170","FALLON - FALLON HMO STANDARD - J1170","FALLON - FALLON HMO STANDARD - J1170 - PR HYDROMORPHONE INJECTION","FALLON","FALLON HMO STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,21.32,15.35,456.36,10.66]
["FALLON - FALLON HMO STANDARD - HCPCS - J2704","FALLON - FALLON HMO STANDARD - J2704","FALLON - FALLON HMO STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","FALLON","FALLON HMO STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.22,0.88,456.36,0.61]
["FALLON - FALLON HMO STANDARD - HCPCS - J3490","FALLON - FALLON HMO STANDARD - J3490","FALLON - FALLON HMO STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON","FALLON HMO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,15.81,11.38,456.36,7.91]
["FALLON - FALLON POS STANDARD - HCPCS - J1170","FALLON - FALLON POS STANDARD - J1170","FALLON - FALLON POS STANDARD - J1170 - PR HYDROMORPHONE INJECTION","FALLON","FALLON POS STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.32,0.23,456.36,0.16]
["FALLON - FALLON POS STANDARD - HCPCS - J2001","FALLON - FALLON POS STANDARD - J2001","FALLON - FALLON POS STANDARD - J2001 - PR LIDOCAINE INJECTION","FALLON","FALLON POS STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.41,0.03,456.36,0.2]
["FALLON - FALLON POS STANDARD - HCPCS - J2704","FALLON - FALLON POS STANDARD - J2704","FALLON - FALLON POS STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","FALLON","FALLON POS STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,14.93,2.15,456.36,7.46]
["FALLON - FALLON POS STANDARD - HCPCS - J3590","FALLON - FALLON POS STANDARD - J3590","FALLON - FALLON POS STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","FALLON","FALLON POS STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,609,420.34,1218,304.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J0690","FALLON - FALLON PPO STANDARD - J0690","FALLON - FALLON PPO STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON","FALLON PPO STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.63,1.17,456.36,0.81]
["FALLON - FALLON PPO STANDARD - HCPCS - J1953","FALLON - FALLON PPO STANDARD - J1953","FALLON - FALLON PPO STANDARD - J1953 - PR LEVETIRACETAM INJECTION","FALLON","FALLON PPO STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,25.76,10.5,456.36,12.88]
["FALLON - FALLON PPO STANDARD - HCPCS - J2704","FALLON - FALLON PPO STANDARD - J2704","FALLON - FALLON PPO STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","FALLON","FALLON PPO STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,14.93,2.15,456.36,7.46]
["FALLON - FALLON PPO STANDARD - HCPCS - J3490","FALLON - FALLON PPO STANDARD - J3490","FALLON - FALLON PPO STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON","FALLON PPO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,3838.41,420.34,7676.82,1919.21]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0736","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J0736","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2704","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J2704","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J2704 - PR INJ, PROPFOL, 10 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3301","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J3301","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1170","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J1170","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J1170 - PR HYDROMORPHONE INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2001","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J2001","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J2001 - PR LIDOCAINE INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2704","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J2704","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J2704 - PR INJ, PROPFOL, 10 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - P9047","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - P9047","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J1953","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J1953","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J1953 - PR LEVETIRACETAM INJECTION","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J2001","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J2001","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J2001 - PR LIDOCAINE INJECTION","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["FALLON SCO - FALLON SCO HMO - HCPCS - J0583","FALLON SCO - FALLON SCO HMO - J0583","FALLON SCO - FALLON SCO HMO - J0583 - PR BIVALIRUDIN","FALLON SCO","FALLON SCO HMO","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["FALLON SCO - FALLON SCO HMO - HCPCS - J1815","FALLON SCO - FALLON SCO HMO - J1815","FALLON SCO - FALLON SCO HMO - J1815 - PR INSULIN INJECTION","FALLON SCO","FALLON SCO HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2270","FALLON SCO - FALLON SCO HMO - J2270","FALLON SCO - FALLON SCO HMO - J2270 - PR MORPHINE SULFATE INJECTION","FALLON SCO","FALLON SCO HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["FALLON SCO - FALLON SCO HMO - HCPCS - J3590","FALLON SCO - FALLON SCO HMO - J3590","FALLON SCO - FALLON SCO HMO - J3590 - PR UNCLASSIFIED BIOLOGICS","FALLON SCO","FALLON SCO HMO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["FALLON SCO - FALLON SCO HMO - HCPCS - J9041","FALLON SCO - FALLON SCO HMO - J9041","FALLON SCO - FALLON SCO HMO - J9041 - PR INJ., VELCADE 0.1 MG","FALLON SCO","FALLON SCO HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J1815","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J1815","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J1815 - PR INSULIN INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J2704 - PR INJ, PROPFOL, 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J0137","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J0137","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.66]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J1170","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J1170","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J1170 - PR HYDROMORPHONE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J2919","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J2919","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,73.180000000000007,52.37,456.36,36.369999999999997]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J3490","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J3490","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,8.89,6.4,456.36,4.4400000000000004]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J1170","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J1170","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J1170 - PR HYDROMORPHONE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",444.07,444.07,23.8,456.36,111.02]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J3490","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J3490","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,15.81,11.38,456.36,7.91]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J1953","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J1953","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J1953 - PR LEVETIRACETAM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J2270","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J2270","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J2270 - PR MORPHINE SULFATE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J1580","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J1580","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J1580 - PR GARAMYCIN GENTAMICIN INJ","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J2704 - PR INJ, PROPFOL, 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - A9576","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - A9576","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - A9576 - INJ PROHANCE MULTIPACK","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J1953","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J1953","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J1953 - PR LEVETIRACETAM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J3010","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J3010","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J3010 - PR FENTANYL CITRATE INJECITON","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J3490","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J3490","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,15.81,11.38,456.36,7.91]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J1953","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J1953","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J1953 - PR LEVETIRACETAM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J3010","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J3010","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J3010 - PR FENTANYL CITRATE INJECITON","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J0690","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J0690","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J0690 - PR CEFAZOLIN SODIUM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1170","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J1170","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J1170 - PR HYDROMORPHONE INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2704","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J2704","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J2704 - PR INJ, PROPFOL, 10 MG","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - Q5114","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - Q5114","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - Q5114 - PR INJ OGIVRI 10 MG","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.49,420.34,5223.6099999999997,1536.36]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J1953","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J1953","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J1953 - PR LEVETIRACETAM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J2310","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J2310","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J0690","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J0690","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J1170","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J1170","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J1170 - PR HYDROMORPHONE INJECTION","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J2919","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J2919","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,73.180000000000007,52.37,456.36,36.369999999999997]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J0690","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J0690","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J0690 - PR CEFAZOLIN SODIUM INJECTION","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J1953","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J1953","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J1953 - PR LEVETIRACETAM INJECTION","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2310","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J2310","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J2310 - PR INJ NALOXONE HYDROCHLORIDE","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J9041","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J9041","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J9041 - PR INJ., VELCADE 0.1 MG","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["HSN - HSN STANDARD - HCPCS - J0736","HSN - HSN STANDARD - J0736","HSN - HSN STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","HSN","HSN STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",57.91,456.36,3.81,456.36,14.48]
["HSN - HSN STANDARD - HCPCS - J1815","HSN - HSN STANDARD - J1815","HSN - HSN STANDARD - J1815 - PR INSULIN INJECTION","HSN","HSN STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,456.36,1.79,456.36,1.25]
["HSN - HSN STANDARD - HCPCS - J3490","HSN - HSN STANDARD - J3490","HSN - HSN STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN","HSN STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7444.48,456.36,420.34,7444.48,1861.12]
["HSN - HSN STANDARD - HCPCS - J3490","HSN - HSN STANDARD - J3490","HSN - HSN STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN","HSN STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",3386.11,456.36,420.34,3386.11,846.53]
["HSN - HSN TEMPORARY - HCPCS - J1815","HSN - HSN TEMPORARY - J1815","HSN - HSN TEMPORARY - J1815 - PR INSULIN INJECTION","HSN","HSN TEMPORARY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,456.36,4.55,456.36,3.16]
["HSN - HSN TEMPORARY - HCPCS - J1953","HSN - HSN TEMPORARY - J1953","HSN - HSN TEMPORARY - J1953 - PR LEVETIRACETAM INJECTION","HSN","HSN TEMPORARY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,456.36,7,456.36,26.65]
["HSN - HSN TEMPORARY - HCPCS - J3490","HSN - HSN TEMPORARY - J3490","HSN - HSN TEMPORARY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN","HSN TEMPORARY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,456.36,11.38,456.36,7.91]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J0137","HSN BAD DEBT - HSN BAD DEBT - J0137","HSN BAD DEBT - HSN BAD DEBT - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,456.36,5.0999999999999996,456.36,10.66]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J1815","HSN BAD DEBT - HSN BAD DEBT - J1815","HSN BAD DEBT - HSN BAD DEBT - J1815 - PR INSULIN INJECTION","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,456.36,17.84,456.36,12.39]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2001","HSN BAD DEBT - HSN BAD DEBT - J2001","HSN BAD DEBT - HSN BAD DEBT - J2001 - PR LIDOCAINE INJECTION","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,456.36,1.41,456.36,0.98]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J3490","HSN BAD DEBT - HSN BAD DEBT - J3490","HSN BAD DEBT - HSN BAD DEBT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,456.36,11.38,456.36,7.91]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J0137","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J0137","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,456.36,5.0999999999999996,456.36,10.66]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J1815","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J1815","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J1815 - PR INSULIN INJECTION","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,456.36,4.55,456.36,3.16]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2704","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J2704","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J2704 - PR INJ, PROPFOL, 10 MG","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,456.36,2.15,456.36,7.46]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - Q9967","HSN CONFIDENTIAL - HSN CONFIDENTIAL - Q9967","HSN CONFIDENTIAL - HSN CONFIDENTIAL - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,456.36,0.12,456.36,0.25]
["HSN DENTAL - HSN DENTAL - HCPCS - J1580","HSN DENTAL - HSN DENTAL - J1580","HSN DENTAL - HSN DENTAL - J1580 - PR GARAMYCIN GENTAMICIN INJ","HSN DENTAL","HSN DENTAL","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,456.36,1.37,456.36,0.95]
["HSN DENTAL - HSN DENTAL - HCPCS - J1580","HSN DENTAL - HSN DENTAL - J1580","HSN DENTAL - HSN DENTAL - J1580 - PR GARAMYCIN GENTAMICIN INJ","HSN DENTAL","HSN DENTAL","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,456.36,2.78,456.36,2.31]
["HSN DENTAL - HSN DENTAL - HCPCS - J2704","HSN DENTAL - HSN DENTAL - J2704","HSN DENTAL - HSN DENTAL - J2704 - PR INJ, PROPFOL, 10 MG","HSN DENTAL","HSN DENTAL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,456.36,0.88,456.36,0.61]
["HSN DENTAL - HSN DENTAL - HCPCS - J7131","HSN DENTAL - HSN DENTAL - J7131","HSN DENTAL - HSN DENTAL - J7131 - PR HYPERTONIC SALINE SOL","HSN DENTAL","HSN DENTAL","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,456.36,5.72,456.36,3.97]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1170","HSN PARTIAL - HSN PARTIAL STANDARD - J1170","HSN PARTIAL - HSN PARTIAL STANDARD - J1170 - PR HYDROMORPHONE INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,456.36,61.88,456.36,55.51]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2001","HSN PARTIAL - HSN PARTIAL STANDARD - J2001","HSN PARTIAL - HSN PARTIAL STANDARD - J2001 - PR LIDOCAINE INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,456.36,0.03,456.36,0.2]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2919","HSN PARTIAL - HSN PARTIAL STANDARD - J2919","HSN PARTIAL - HSN PARTIAL STANDARD - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",18.510000000000002,456.36,6.66,456.36,4.63]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J3490","HSN PARTIAL - HSN PARTIAL STANDARD - J3490","HSN PARTIAL - HSN PARTIAL STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,456.36,17.75,456.36,12.33]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1170","HSN PARTIAL - HSN PARTIAL TEMPORARY - J1170","HSN PARTIAL - HSN PARTIAL TEMPORARY - J1170 - PR HYDROMORPHONE INJECTION","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,456.36,0.23,456.36,0.16]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2704","HSN PARTIAL - HSN PARTIAL TEMPORARY - J2704","HSN PARTIAL - HSN PARTIAL TEMPORARY - J2704 - PR INJ, PROPFOL, 10 MG","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,456.36,0.88,456.36,0.61]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J3490","HSN PARTIAL - HSN PARTIAL TEMPORARY - J3490","HSN PARTIAL - HSN PARTIAL TEMPORARY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,456.36,11.38,456.36,7.91]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J1170","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J1170","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J1170 - PR HYDROMORPHONE INJECTION","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2001","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J2001","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J2001 - PR LIDOCAINE INJECTION","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2704","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J2704","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J3590","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J3590","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J0750","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J0750","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J0750 - HIV PREP, FTC/TDF 200/300MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,118.57,1.22,456.36,52.63]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J2001 - PR LIDOCAINE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.2000000000000002,1.41,456.36,0.98]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2919","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J2919","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,81.93,52.37,456.36,36.369999999999997]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J9041","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J9041","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J9041 - PR INJ., VELCADE 0.1 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,3207.23,68.569999999999993,4840.46,1423.67]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J0750","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J0750","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J0750 - HIV PREP, FTC/TDF 200/300MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,118.57,1.22,456.36,52.63]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2704","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J2704","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J2704 - PR INJ, PROPFOL, 10 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.37,0.88,456.36,0.61]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J7131","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J7131","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J7131 - PR HYPERTONIC SALINE SOL","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,8.94,5.72,456.36,3.97]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J0736","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J0736","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,23.71,3.81,456.36,10.53]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J2001 - PR LIDOCAINE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.2000000000000002,1.41,456.36,0.98]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2704","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J2704","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J2704 - PR INJ, PROPFOL, 10 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.37,0.88,456.36,0.61]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J3490","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,49.11,31.39,456.36,21.8]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J1170","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J1170","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J1170 - PR HYDROMORPHONE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,18.190000000000001,9.52,456.36,8.08]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J1815","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J1815","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J1815 - PR INSULIN INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,7.86,5.0199999999999996,456.36,3.49]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2704","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J2704","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J2704 - PR INJ, PROPFOL, 10 MG","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.37,0.88,456.36,0.61]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J3490","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,49.11,31.39,456.36,21.8]
["MEDICARE - MEDICARE A&B - HCPCS - J1815","MEDICARE - MEDICARE A&B - J1815","MEDICARE - MEDICARE A&B - J1815 - PR INSULIN INJECTION","MEDICARE","MEDICARE A&B","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29]
["MEDICARE - MEDICARE A&B - HCPCS - J2001","MEDICARE - MEDICARE A&B - J2001","MEDICARE - MEDICARE A&B - J2001 - PR LIDOCAINE INJECTION","MEDICARE","MEDICARE A&B","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.4700000000000002,2.4700000000000002,0.89,456.36,0.62]
["MEDICARE - MEDICARE A&B - HCPCS - J3490","MEDICARE - MEDICARE A&B - J3490","MEDICARE - MEDICARE A&B - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MEDICARE","MEDICARE A&B","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J0690","MEDICARE - MEDICARE PART A ONLY - J0690","MEDICARE - MEDICARE PART A ONLY - J0690 - PR CEFAZOLIN SODIUM INJECTION","MEDICARE","MEDICARE PART A ONLY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J1953","MEDICARE - MEDICARE PART A ONLY - J1953","MEDICARE - MEDICARE PART A ONLY - J1953 - PR LEVETIRACETAM INJECTION","MEDICARE","MEDICARE PART A ONLY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2704","MEDICARE - MEDICARE PART A ONLY - J2704","MEDICARE - MEDICARE PART A ONLY - J2704 - PR INJ, PROPFOL, 10 MG","MEDICARE","MEDICARE PART A ONLY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3490","MEDICARE - MEDICARE PART A ONLY - J3490","MEDICARE - MEDICARE PART A ONLY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MEDICARE","MEDICARE PART A ONLY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J1953","MEDICARE - MEDICARE PART B ONLY - J1953","MEDICARE - MEDICARE PART B ONLY - J1953 - PR LEVETIRACETAM INJECTION","MEDICARE","MEDICARE PART B ONLY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J2001","MEDICARE - MEDICARE PART B ONLY - J2001","MEDICARE - MEDICARE PART B ONLY - J2001 - PR LIDOCAINE INJECTION","MEDICARE","MEDICARE PART B ONLY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J3010","MEDICARE - MEDICARE PART B ONLY - J3010","MEDICARE - MEDICARE PART B ONLY - J3010 - PR FENTANYL CITRATE INJECITON","MEDICARE","MEDICARE PART B ONLY","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J1815","MEDICARE - RAILROAD MEDICARE  RAILROAD - J1815","MEDICARE - RAILROAD MEDICARE  RAILROAD - J1815 - PR INSULIN INJECTION","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2001","MEDICARE - RAILROAD MEDICARE  RAILROAD - J2001","MEDICARE - RAILROAD MEDICARE  RAILROAD - J2001 - PR LIDOCAINE INJECTION","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2704","MEDICARE - RAILROAD MEDICARE  RAILROAD - J2704","MEDICARE - RAILROAD MEDICARE  RAILROAD - J2704 - PR INJ, PROPFOL, 10 MG","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J0690","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J0690","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J1815","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J1815","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J1815 - PR INSULIN INJECTION","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2704","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J2704","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J3490","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J3490","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J1170","OXFORD HEALTH - OXFORD HEALTH STANDARD - J1170","OXFORD HEALTH - OXFORD HEALTH STANDARD - J1170 - PR HYDROMORPHONE INJECTION","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2001","OXFORD HEALTH - OXFORD HEALTH STANDARD - J2001","OXFORD HEALTH - OXFORD HEALTH STANDARD - J2001 - PR LIDOCAINE INJECTION","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J7121","OXFORD HEALTH - OXFORD HEALTH STANDARD - J7121","OXFORD HEALTH - OXFORD HEALTH STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J9041","OXFORD HEALTH - OXFORD HEALTH STANDARD - J9041","OXFORD HEALTH - OXFORD HEALTH STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2001","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J2001","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J2001 - PR LIDOCAINE INJECTION","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J3490","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J3490","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J3490","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J3490","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J1170","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J1170","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J1170 - PR HYDROMORPHONE INJECTION","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,222.04,61.88,456.36,55.51]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2001","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J2001","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J2001 - PR LIDOCAINE INJECTION","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J3490","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J3490","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - Q9967","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - Q9967","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,116,0.12,456.36,29]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1815","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J1815","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J1815 - PR INSULIN INJECTION","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2704","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J2704","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J3490","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J3490","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J1953","TRICARE EAST - TRICARE EAST PRIME (HMO) - J1953","TRICARE EAST - TRICARE EAST PRIME (HMO) - J1953 - PR LEVETIRACETAM INJECTION","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2704","TRICARE EAST - TRICARE EAST PRIME (HMO) - J2704","TRICARE EAST - TRICARE EAST PRIME (HMO) - J2704 - PR INJ, PROPFOL, 10 MG","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J3490","TRICARE EAST - TRICARE EAST PRIME (HMO) - J3490","TRICARE EAST - TRICARE EAST PRIME (HMO) - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J0690","TRICARE EAST - TRICARE EAST SELECT - J0690","TRICARE EAST - TRICARE EAST SELECT - J0690 - PR CEFAZOLIN SODIUM INJECTION","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2001","TRICARE EAST - TRICARE EAST SELECT - J2001","TRICARE EAST - TRICARE EAST SELECT - J2001 - PR LIDOCAINE INJECTION","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2704","TRICARE EAST - TRICARE EAST SELECT - J2704","TRICARE EAST - TRICARE EAST SELECT - J2704 - PR INJ, PROPFOL, 10 MG","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - P9047","TRICARE EAST - TRICARE EAST SELECT - P9047","TRICARE EAST - TRICARE EAST SELECT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TRICARE EAST","TRICARE EAST SELECT","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,50.13,50.13,456.36,46.75]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J1170","TRICARE FOR LIFE - TRICARE FOR LIFE - J1170","TRICARE FOR LIFE - TRICARE FOR LIFE - J1170 - PR HYDROMORPHONE INJECTION","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J2001","TRICARE FOR LIFE - TRICARE FOR LIFE - J2001","TRICARE FOR LIFE - TRICARE FOR LIFE - J2001 - PR LIDOCAINE INJECTION","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J3490","TRICARE FOR LIFE - TRICARE FOR LIFE - J3490","TRICARE FOR LIFE - TRICARE FOR LIFE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8]
["TUFTS - TUFTS CARELINK - HCPCS - J1561","TUFTS - TUFTS CARELINK - J1561","TUFTS - TUFTS CARELINK - J1561 - PR GAMUNEX-C/GAMMAKED","TUFTS","TUFTS CARELINK","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,487.48,417.75,7890.89,290.11]
["TUFTS - TUFTS CARELINK - HCPCS - J2001","TUFTS - TUFTS CARELINK - J2001","TUFTS - TUFTS CARELINK - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS CARELINK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["TUFTS - TUFTS CARELINK - HCPCS - J2704","TUFTS - TUFTS CARELINK - J2704","TUFTS - TUFTS CARELINK - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS CARELINK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["TUFTS - TUFTS CARELINK - HCPCS - J9041","TUFTS - TUFTS CARELINK - J9041","TUFTS - TUFTS CARELINK - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS","TUFTS CARELINK","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,941.9,68.569999999999993,4840.46,1423.67]
["TUFTS - TUFTS HMO - HCPCS - J0690","TUFTS - TUFTS HMO - J0690","TUFTS - TUFTS HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS","TUFTS HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,30.2,3.16,456.36,7.55]
["TUFTS - TUFTS HMO - HCPCS - J2001","TUFTS - TUFTS HMO - J2001","TUFTS - TUFTS HMO - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["TUFTS - TUFTS HMO - HCPCS - J2704","TUFTS - TUFTS HMO - J2704","TUFTS - TUFTS HMO - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["TUFTS - TUFTS HMO - HCPCS - J9041","TUFTS - TUFTS HMO - J9041","TUFTS - TUFTS HMO - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS","TUFTS HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,884.68,68.569999999999993,4840.46,1423.67]
["TUFTS - TUFTS POS - HCPCS - J0750","TUFTS - TUFTS POS - J0750","TUFTS - TUFTS POS - J0750 - HIV PREP, FTC/TDF 200/300MG","TUFTS","TUFTS POS","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,95.92,1.22,456.36,52.63]
["TUFTS - TUFTS POS - HCPCS - J2704","TUFTS - TUFTS POS - J2704","TUFTS - TUFTS POS - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["TUFTS - TUFTS POS - HCPCS - J2704","TUFTS - TUFTS POS - J2704","TUFTS - TUFTS POS - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["TUFTS - TUFTS PPO - HCPCS - J0736","TUFTS - TUFTS PPO - J0736","TUFTS - TUFTS PPO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","TUFTS","TUFTS PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,6.27,1.9,456.36,1.57]
["TUFTS - TUFTS PPO - HCPCS - J1815","TUFTS - TUFTS PPO - J1815","TUFTS - TUFTS PPO - J1815 - PR INSULIN INJECTION","TUFTS","TUFTS PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,30.11,23.79,456.36,16.52]
["TUFTS - TUFTS PPO - HCPCS - J2001","TUFTS - TUFTS PPO - J2001","TUFTS - TUFTS PPO - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["TUFTS - TUFTS PPO - HCPCS - J3490","TUFTS - TUFTS PPO - J3490","TUFTS - TUFTS PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS","TUFTS PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004]
["TUFTS - TUFTS SELECT - HCPCS - J1170","TUFTS - TUFTS SELECT - J1170","TUFTS - TUFTS SELECT - J1170 - PR HYDROMORPHONE INJECTION","TUFTS","TUFTS SELECT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13]
["TUFTS - TUFTS SELECT - HCPCS - J1815","TUFTS - TUFTS SELECT - J1815","TUFTS - TUFTS SELECT - J1815 - PR INSULIN INJECTION","TUFTS","TUFTS SELECT","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52]
["TUFTS - TUFTS SELECT - HCPCS - J2001","TUFTS - TUFTS SELECT - J2001","TUFTS - TUFTS SELECT - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS SELECT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17]
["TUFTS - TUFTS SPIRIT - HCPCS - J0690","TUFTS - TUFTS SPIRIT - J0690","TUFTS - TUFTS SPIRIT - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS","TUFTS SPIRIT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["TUFTS - TUFTS SPIRIT - HCPCS - J1815","TUFTS - TUFTS SPIRIT - J1815","TUFTS - TUFTS SPIRIT - J1815 - PR INSULIN INJECTION","TUFTS","TUFTS SPIRIT","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25]
["TUFTS - TUFTS SPIRIT - HCPCS - J2001","TUFTS - TUFTS SPIRIT - J2001","TUFTS - TUFTS SPIRIT - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS SPIRIT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["TUFTS - TUFTS SPIRIT - HCPCS - J2704","TUFTS - TUFTS SPIRIT - J2704","TUFTS - TUFTS SPIRIT - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS SPIRIT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J0690","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,420.34,1.17,456.36,0.81]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J1953","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,420.34,7,456.36,26.65]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J2001","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,420.34,1.03,456.36,0.71]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J3490","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,420.34,17.75,456.36,12.33]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J0690","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,420.34,1.17,456.36,0.81]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J1953","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,420.34,10.5,456.36,12.88]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2919","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J2919","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,420.34,52.37,456.36,36.369999999999997]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J0583","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,420.34,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1561","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J1561","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J1561 - PR GAMUNEX-C/GAMMAKED","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",232.09,420.34,83.55,456.36,58.02]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J2001","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,420.34,1.41,456.36,0.98]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J2704","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,420.34,2.15,456.36,7.46]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J9041","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J9041","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,420.34,68.569999999999993,4840.46,1423.67]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1580","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J1580","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J2001","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J3490","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J0690","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,420.34,1.17,456.36,0.81]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J1953","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,420.34,3.5,456.36,16.43]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J2001","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,420.34,1.41,456.36,0.98]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0137","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J0137","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,7.06,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J1170","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J2001","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J2704","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J0690","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,420.34,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1580","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J1580","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,420.34,3.65,456.36,2.5299999999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J2001","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,420.34,1.03,456.36,0.71]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J3490","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,420.34,11.38,456.36,7.91]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J0137","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J0137","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,7.06,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1815","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J1815","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J1815 - PR INSULIN INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J3490","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J0690","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,420.34,1.17,456.36,0.81]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J1953","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,420.34,7,456.36,26.65]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J2001","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,420.34,1.03,456.36,0.71]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J7608","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J7608","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J7608 - ACETYLCYSTEINE NON-COMP UNIT","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,420.34,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J0690","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J1580","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J1580","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3490","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3490","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1815","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J1815","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J1815 - PR INSULIN INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,420.34,4.55,456.36,10.52]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J1953","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,420.34,7,456.36,26.65]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J3490","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,420.34,420.34,7676.82,1919.21]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J0583","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J1250","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J2001","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J7131","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J7131","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J7131 - PR HYPERTONIC SALINE SOL","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J0690","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,420.34,11.86,456.36,8.24]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1815","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J1815","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J1815 - PR INSULIN INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,420.34,73.12,456.36,50.78]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J3490","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,420.34,31.39,456.36,21.8]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J0690","TUFTS MEDICARE - TUFTS MEDICARE HMO - J0690","TUFTS MEDICARE - TUFTS MEDICARE HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J0736","TUFTS MEDICARE - TUFTS MEDICARE HMO - J0736","TUFTS MEDICARE - TUFTS MEDICARE HMO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2704","TUFTS MEDICARE - TUFTS MEDICARE HMO - J2704","TUFTS MEDICARE - TUFTS MEDICARE HMO - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J3490","TUFTS MEDICARE - TUFTS MEDICARE HMO - J3490","TUFTS MEDICARE - TUFTS MEDICARE HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,7676.82,420.34,7676.82,1919.21]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1170","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J1170","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J1170 - PR HYDROMORPHONE INJECTION","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1815","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J1815","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J1815 - PR INSULIN INJECTION","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2704","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J2704","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J0137","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J0137","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J1170","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J1170","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J1170 - PR HYDROMORPHONE INJECTION","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J2001","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J2001","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J9041","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J9041","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1580","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J1580","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J2270","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J2270","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J2270 - PR MORPHINE SULFATE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J3490","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J3490","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J0736","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J0736","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,3.81,3.81,456.36,10.53]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J1953","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J1953","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J1953 - PR LEVETIRACETAM INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2001","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J2001","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J3490","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J3490","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J0736","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J0736","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2001","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J2001","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2704","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J2704","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["UBH HPHC - UBH HPHC - HCPCS - J0736","UBH HPHC - UBH HPHC - J0736","UBH HPHC - UBH HPHC - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","UBH HPHC","UBH HPHC","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41]
["UBH HPHC - UBH HPHC - HCPCS - J2001","UBH HPHC - UBH HPHC - J2001","UBH HPHC - UBH HPHC - J2001 - PR LIDOCAINE INJECTION","UBH HPHC","UBH HPHC","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["UBH HPHC - UBH HPHC - HCPCS - J2704","UBH HPHC - UBH HPHC - J2704","UBH HPHC - UBH HPHC - J2704 - PR INJ, PROPFOL, 10 MG","UBH HPHC","UBH HPHC","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["UNICARE - UNICARE STANDARD - HCPCS - J0690","UNICARE - UNICARE STANDARD - J0690","UNICARE - UNICARE STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNICARE","UNICARE STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.58,1.17,456.36,0.81]
["UNICARE - UNICARE STANDARD - HCPCS - J1580","UNICARE - UNICARE STANDARD - J1580","UNICARE - UNICARE STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","UNICARE","UNICARE STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,2.78,2.78,456.36,92.37]
["UNICARE - UNICARE STANDARD - HCPCS - J2001","UNICARE - UNICARE STANDARD - J2001","UNICARE - UNICARE STANDARD - J2001 - PR LIDOCAINE INJECTION","UNICARE","UNICARE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.14,1.03,456.36,0.71]
["UNICARE - UNICARE STANDARD - HCPCS - J2704","UNICARE - UNICARE STANDARD - J2704","UNICARE - UNICARE STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","UNICARE","UNICARE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,0.91,0.88,456.36,0.61]
["UNICARE - UNICARE STANDARD - HCPCS - Q9967","UNICARE - UNICARE STANDARD - Q9967","UNICARE - UNICARE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNICARE","UNICARE STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,0.12,0.12,456.36,29]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1170","UNITED - UNITED DEFINITY HRA - J1170","UNITED - UNITED DEFINITY HRA - J1170 - PR HYDROMORPHONE INJECTION","UNITED","UNITED DEFINITY HRA","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02]
["UNITED - UNITED DEFINITY HRA - HCPCS - J2704","UNITED - UNITED DEFINITY HRA - J2704","UNITED - UNITED DEFINITY HRA - J2704 - PR INJ, PROPFOL, 10 MG","UNITED","UNITED DEFINITY HRA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["UNITED - UNITED HP SHIP - HCPCS - J0583","UNITED - UNITED HP SHIP - J0583","UNITED - UNITED HP SHIP - J0583 - PR BIVALIRUDIN","UNITED","UNITED HP SHIP","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["UNITED - UNITED HP SHIP - HCPCS - J1170","UNITED - UNITED HP SHIP - J1170","UNITED - UNITED HP SHIP - J1170 - PR HYDROMORPHONE INJECTION","UNITED","UNITED HP SHIP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91]
["UNITED - UNITED HP SHIP - HCPCS - J2704","UNITED - UNITED HP SHIP - J2704","UNITED - UNITED HP SHIP - J2704 - PR INJ, PROPFOL, 10 MG","UNITED","UNITED HP SHIP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49]
["UNITED - UNITED HP SHIP - HCPCS - J3490","UNITED - UNITED HP SHIP - J3490","UNITED - UNITED HP SHIP - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED","UNITED HP SHIP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,8.89,6.4,456.36,4.4400000000000004]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1170","UNITED - UNITED HP STUDENT HEALTH - J1170","UNITED - UNITED HP STUDENT HEALTH - J1170 - PR HYDROMORPHONE INJECTION","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J2001","UNITED - UNITED HP STUDENT HEALTH - J2001","UNITED - UNITED HP STUDENT HEALTH - J2001 - PR LIDOCAINE INJECTION","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J2919","UNITED - UNITED HP STUDENT HEALTH - J2919","UNITED - UNITED HP STUDENT HEALTH - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,73.180000000000007,52.37,456.36,36.369999999999997]
["UNITED - UNITED NAVIGATE - HCPCS - J1580","UNITED - UNITED NAVIGATE - J1580","UNITED - UNITED NAVIGATE - J1580 - PR GARAMYCIN GENTAMICIN INJ","UNITED","UNITED NAVIGATE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46]
["UNITED - UNITED NAVIGATE - HCPCS - J1953","UNITED - UNITED NAVIGATE - J1953","UNITED - UNITED NAVIGATE - J1953 - PR LEVETIRACETAM INJECTION","UNITED","UNITED NAVIGATE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43]
["UNITED - UNITED NAVIGATE - HCPCS - J3490","UNITED - UNITED NAVIGATE - J3490","UNITED - UNITED NAVIGATE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED","UNITED NAVIGATE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J0750","UNITED - UNITED PASSPORT CONNECT - J0750","UNITED - UNITED PASSPORT CONNECT - J0750 - HIV PREP, FTC/TDF 200/300MG","UNITED","UNITED PASSPORT CONNECT","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,1.22,1.22,456.36,52.63]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J1953","UNITED - UNITED PASSPORT CONNECT - J1953","UNITED - UNITED PASSPORT CONNECT - J1953 - PR LEVETIRACETAM INJECTION","UNITED","UNITED PASSPORT CONNECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J2704","UNITED - UNITED PASSPORT CONNECT - J2704","UNITED - UNITED PASSPORT CONNECT - J2704 - PR INJ, PROPFOL, 10 MG","UNITED","UNITED PASSPORT CONNECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["UNITED - UNITED STANDARD - HCPCS - J0690","UNITED - UNITED STANDARD - J0690","UNITED - UNITED STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED","UNITED STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2]
["UNITED - UNITED STANDARD - HCPCS - J1815","UNITED - UNITED STANDARD - J1815","UNITED - UNITED STANDARD - J1815 - PR INSULIN INJECTION","UNITED","UNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52]
["UNITED - UNITED STANDARD - HCPCS - J2310","UNITED - UNITED STANDARD - J2310","UNITED - UNITED STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","UNITED","UNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["UNITED - UNITED STANDARD - HCPCS - J3490","UNITED - UNITED STANDARD - J3490","UNITED - UNITED STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED","UNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J0690","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J0690","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J2001","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J2001","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J2001 - PR LIDOCAINE INJECTION","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J7121","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J7121","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J9041","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J9041","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J9041 - PR INJ., VELCADE 0.1 MG","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J2001","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J2001","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J2001 - PR LIDOCAINE INJECTION","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J2704","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J2704","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J0137","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J0137","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J0702","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J0702","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J2001","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J2001","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J2001 - PR LIDOCAINE INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J3490","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J3490","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J0137","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J0137","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J1817","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J1817","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J1817 - PR INSULIN FOR INSULIN PUMP USE","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2704","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J2704","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J2704 - PR INJ, PROPFOL, 10 MG","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J0690","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J0690","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J1953","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J1953","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J1953 - PR LEVETIRACETAM INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J2704","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J2704","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J2704 - PR INJ, PROPFOL, 10 MG","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J9041","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J9041","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J9041 - PR INJ., VELCADE 0.1 MG","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J1170","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J1170","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J1170 - PR HYDROMORPHONE INJECTION","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J2310","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J2310","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J2704","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J2704","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J2704 - PR INJ, PROPFOL, 10 MG","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - C9113","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - C9113","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J1580","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J1580","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J1580 - PR GARAMYCIN GENTAMICIN INJ","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,9.24,2.78,456.36,2.31]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J2001","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J2001","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J2001 - PR LIDOCAINE INJECTION","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J7131","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J7131","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J7131 - PR HYPERTONIC SALINE SOL","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1815","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J1815","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J1815 - PR INSULIN INJECTION","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,19.82,17.84,456.36,12.39]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J2001","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J2001","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J2001 - PR LIDOCAINE INJECTION","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.1399999999999999,1.03,456.36,0.71]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J3490","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J3490","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,0.64,0.57999999999999996,456.36,0.4]
["WELLCARE - WELLCARE HMO - HCPCS - J0137","WELLCARE - WELLCARE HMO - J0137","WELLCARE - WELLCARE HMO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","WELLCARE","WELLCARE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.3,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE HMO - HCPCS - J1170","WELLCARE - WELLCARE HMO - J1170","WELLCARE - WELLCARE HMO - J1170 - PR HYDROMORPHONE INJECTION","WELLCARE","WELLCARE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",444.07,444.07,23.8,456.36,111.02]
["WELLCARE - WELLCARE HMO - HCPCS - J2310","WELLCARE - WELLCARE HMO - J2310","WELLCARE - WELLCARE HMO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WELLCARE","WELLCARE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["WELLCARE - WELLCARE HMO - HCPCS - J3490","WELLCARE - WELLCARE HMO - J3490","WELLCARE - WELLCARE HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLCARE","WELLCARE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",3386.11,3386.11,420.34,3386.11,846.53]
["WELLCARE - WELLCARE PPO - HCPCS - J0690","WELLCARE - WELLCARE PPO - J0690","WELLCARE - WELLCARE PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25]
["WELLCARE - WELLCARE PPO - HCPCS - J1815","WELLCARE - WELLCARE PPO - J1815","WELLCARE - WELLCARE PPO - J1815 - PR INSULIN INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25]
["WELLCARE - WELLCARE PPO - HCPCS - J3490","WELLCARE - WELLCARE PPO - J3490","WELLCARE - WELLCARE PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8]
["WELLCARE - WELLCARE STANDARD - HCPCS - J0131","WELLCARE - WELLCARE STANDARD - J0131","WELLCARE - WELLCARE STANDARD - J0131 - PR ACETAMINOPHEN INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.3,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1953","WELLCARE - WELLCARE STANDARD - J1953","WELLCARE - WELLCARE STANDARD - J1953 - PR LEVETIRACETAM INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2310","WELLCARE - WELLCARE STANDARD - J2310","WELLCARE - WELLCARE STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WELLCARE","WELLCARE STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["WELLCARE - WELLCARE STANDARD - HCPCS - J3490","WELLCARE - WELLCARE STANDARD - J3490","WELLCARE - WELLCARE STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",102.67,102.67,36.96,456.36,25.67]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J0736","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J0736","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,2.02,1.9,456.36,1.41]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J1815","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J1815","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J1815 - PR INSULIN INJECTION","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,1.79,1.79,456.36,1.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2704","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J2704","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J2704 - PR INJ, PROPFOL, 10 MG","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,2.15,2.15,456.36,1.49]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J3490","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J3490","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,11.38,11.38,456.36,7.91]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J0736","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J0736","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",14.75,5.71,5.31,456.36,3.69]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2310","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J2310","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J3490","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J3490","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - S0020","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - S0020","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2001","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J2001","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J2001 - PR LIDOCAINE INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2704","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J2704","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J2704 - PR INJ, PROPFOL, 10 MG","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J7131","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J7131","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J7131 - PR HYPERTONIC SALINE SOL","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1170","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J1170","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.27,0.23,456.36,0.16]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J2001","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J2001","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J3490","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J3490","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,30.8,25.95,456.36,18.02]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J0750","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J0750","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J0750 - HIV PREP, FTC/TDF 200/300MG","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,89.98,1.22,456.36,52.63]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1170","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J1170","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,15.41,12.98,456.36,9.02]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2704","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J2704","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,12.76,2.15,456.36,7.46]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J3490","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J3490","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.98,13.67,11.51,456.36,8]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - Q9967","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - Q9967","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,49.58,0.12,456.36,29]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1953","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J1953","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,45.55,7,456.36,26.65]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2704","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J2704","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,2.5499999999999998,2.15,456.36,1.49]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J3490","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J3490","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,328.52,198.58,768.65,192.16]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J0690","WORKERS COMP - WORKERS COMP CCMSI - J0690","WORKERS COMP - WORKERS COMP CCMSI - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,8.89,3.16,456.36,5.2]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1953","WORKERS COMP - WORKERS COMP CCMSI - J1953","WORKERS COMP - WORKERS COMP CCMSI - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,15.95,3.5,456.36,9.33]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J2704","WORKERS COMP - WORKERS COMP CCMSI - J2704","WORKERS COMP - WORKERS COMP CCMSI - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J3490","WORKERS COMP - WORKERS COMP CCMSI - J3490","WORKERS COMP - WORKERS COMP CCMSI - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,0.48,0.41,456.36,0.28000000000000003]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1815","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J1815","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J1815 - PR INSULIN INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,2.13,1.79,456.36,1.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J2001","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J2001","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J3490","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J3490","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,126.36,106.43,456.36,73.91]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J3490","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J3490","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,0.68,0.57999999999999996,456.36,0.4]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J1561","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J1561","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J1561 - PR GAMUNEX-C/GAMMAKED","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",2320.85,991.93,417.75,7890.89,580.21]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2001","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J2001","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.11,0.03,456.36,7.0000000000000007E-2]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2919","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J2919","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,62.18,52.37,456.36,36.369999999999997]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J0690","WORKERS COMP - WORKERS COMP COVE RISK - J0690","WORKERS COMP - WORKERS COMP COVE RISK - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,5.55,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J1561","WORKERS COMP - WORKERS COMP COVE RISK - J1561","WORKERS COMP - WORKERS COMP COVE RISK - J1561 - PR GAMUNEX-C/GAMMAKED","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",2320.85,991.93,420.34,1972.72,580.21]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2310","WORKERS COMP - WORKERS COMP COVE RISK - J2310","WORKERS COMP - WORKERS COMP COVE RISK - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,46.71,15.14,456.36,27.32]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J0137","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J0137","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,18.22,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1170","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J1170","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,0.89,0.75,456.36,0.52]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1953","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J1953","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,28.09,3.5,456.36,16.43]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2704","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J2704","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,32.799999999999997,13,456.36,19.190000000000001]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J7121","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J7121","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J7121 - PR 5% DEXTROSE IN LAC RINGERS","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,6.07,5.12,456.36,3.55]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1170","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J1170","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,15.41,12.98,456.36,9.02]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1953","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J1953","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,45.55,7,456.36,26.65]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J2704","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J2704","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J7121","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J7121","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J7121 - PR 5% DEXTROSE IN LAC RINGERS","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,9.11,3.84,456.36,5.33]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1953","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J1953","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,15.95,3.5,456.36,9.33]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1953","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J1953","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,22.02,10.5,456.36,12.88]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J3490","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J3490","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,0.68,0.57999999999999996,456.36,0.4]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J0690","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J0690","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,14.08,11.86,456.36,8.24]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1561","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J1561","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J1561 - PR GAMUNEX-C/GAMMAKED","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,1983.86,417.75,7890.89,1160.43]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J2310","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J2310","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,2.06,1.73,456.36,1.2]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J3490","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J3490","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,13.51,11.38,456.36,7.91]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J0690","WORKERS COMP - WORKERS COMP MBTA - J0690","WORKERS COMP - WORKERS COMP MBTA - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.39,1.17,456.36,0.81]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J1580","WORKERS COMP - WORKERS COMP MBTA - J1580","WORKERS COMP - WORKERS COMP MBTA - J1580 - PR GARAMYCIN GENTAMICIN INJ","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,1.63,1.37,456.36,0.95]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2919","WORKERS COMP - WORKERS COMP MBTA - J2919","WORKERS COMP - WORKERS COMP MBTA - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,5.59,4.71,456.36,3.27]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J0690","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J0690","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,8.89,3.16,456.36,5.2]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1561","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J1561","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J1561 - PR GAMUNEX-C/GAMMAKED","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,495.97,417.75,7890.89,290.11]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2310","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J2310","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,2.06,1.73,456.36,1.2]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2919","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J2919","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,5.59,4.71,456.36,3.27]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J0690","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J0690","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.39,1.17,456.36,0.81]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J1170","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J1170","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,1.4,1.18,456.36,0.82]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2001","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2001","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2919","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2919","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,62.18,52.37,456.36,36.369999999999997]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J0137","WORKERS COMP - WORKERS COMP STANDARD - J0137","WORKERS COMP - WORKERS COMP STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,18.22,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2001","WORKERS COMP - WORKERS COMP STANDARD - J2001","WORKERS COMP - WORKERS COMP STANDARD - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2704","WORKERS COMP - WORKERS COMP STANDARD - J2704","WORKERS COMP - WORKERS COMP STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,12.76,2.15,456.36,7.46]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J7131","WORKERS COMP - WORKERS COMP STANDARD - J7131","WORKERS COMP - WORKERS COMP STANDARD - J7131 - PR HYPERTONIC SALINE SOL","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,6.79,5.72,456.36,3.97]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J1170","WORKERS COMP - WORKERS COMP THE HARTFORD - J1170","WORKERS COMP - WORKERS COMP THE HARTFORD - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,20.09,16.920000000000002,456.36,11.75]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2001","WORKERS COMP - WORKERS COMP THE HARTFORD - J2001","WORKERS COMP - WORKERS COMP THE HARTFORD - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2704","WORKERS COMP - WORKERS COMP THE HARTFORD - J2704","WORKERS COMP - WORKERS COMP THE HARTFORD - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J7131","WORKERS COMP - WORKERS COMP THE HARTFORD - J7131","WORKERS COMP - WORKERS COMP THE HARTFORD - J7131 - PR HYPERTONIC SALINE SOL","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,6.79,5.72,456.36,3.97]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J0690","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J0690","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,14.08,11.86,456.36,8.24]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2001","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J2001","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2704","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J2704","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,32.799999999999997,13,456.36,19.190000000000001]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J7131","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J7131","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J7131 - PR HYPERTONIC SALINE SOL","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,6.79,5.72,456.36,3.97]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0736","WORKERS COMP - ZZZWORKERS COMP AIG - J0736","WORKERS COMP - ZZZWORKERS COMP AIG - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,11.92,1.9,456.36,6.97]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J2704","WORKERS COMP - ZZZWORKERS COMP AIG - J2704","WORKERS COMP - ZZZWORKERS COMP AIG - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,3.13,2.6,456.36,1.83]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J3301","WORKERS COMP - ZZZWORKERS COMP AIG - J3301","WORKERS COMP - ZZZWORKERS COMP AIG - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,6.41,0.98,456.36,3.75]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J0690","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J0690","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,5.55,4.32,456.36,3.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1953","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J1953","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,15.95,3.5,456.36,9.33]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2704","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J2704","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J3490","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J3490","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,21.08,17.75,456.36,12.33]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - Q9967","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - Q9967","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J1815","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J1815","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J1815 - PR INSULIN INJECTION","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,21.18,17.84,456.36,12.39]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J2001","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J3490","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J3490","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,37.270000000000003,31.39,456.36,21.8]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1580","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J1580","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J1580 - PR GARAMYCIN GENTAMICIN INJ","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,1.63,1.37,456.36,0.95]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J2001","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.35,0.03,456.36,0.2]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2310","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J2310","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,2.06,1.73,456.36,1.2]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - Q9967","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - Q9967","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1580","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J1580","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J1580 - PR GARAMYCIN GENTAMICIN INJ","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,4.8600000000000003,4.09,456.36,2.84]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J2001","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2704","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J2704","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J0690","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J0690","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.39,1.17,456.36,0.81]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J1170","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J1170","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,13.81,9.52,456.36,8.08]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2704","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J2704","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J7121","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J7121","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J7121 - PR 5% DEXTROSE IN LAC RINGERS","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,4.5599999999999996,3.84,456.36,2.67]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J0750","ZZZAETNA - ZZZAETNA HMO - J0750","ZZZAETNA - ZZZAETNA HMO - J0750 - HIV PREP, FTC/TDF 200/300MG","ZZZAETNA","ZZZAETNA HMO","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,111.37,1.22,456.36,52.63]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J1953","ZZZAETNA - ZZZAETNA HMO - J1953","ZZZAETNA - ZZZAETNA HMO - J1953 - PR LEVETIRACETAM INJECTION","ZZZAETNA","ZZZAETNA HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,19.739999999999998,3.5,456.36,9.33]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J2001","ZZZAETNA - ZZZAETNA HMO - J2001","ZZZAETNA - ZZZAETNA HMO - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.0699999999999998,1.41,456.36,0.98]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3490","ZZZAETNA - ZZZAETNA HMO - J3490","ZZZAETNA - ZZZAETNA HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZAETNA","ZZZAETNA HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,21.97,14.95,456.36,10.38]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J0736","ZZZAETNA - ZZZAETNA MCR SUPP - J0736","ZZZAETNA - ZZZAETNA MCR SUPP - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,22.27,3.81,456.36,10.53]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J1953","ZZZAETNA - ZZZAETNA MCR SUPP - J1953","ZZZAETNA - ZZZAETNA MCR SUPP - J1953 - PR LEVETIRACETAM INJECTION","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,27.25,10.5,456.36,12.88]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2001","ZZZAETNA - ZZZAETNA MCR SUPP - J2001","ZZZAETNA - ZZZAETNA MCR SUPP - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.43,0.03,456.36,0.2]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - Q5114","ZZZAETNA - ZZZAETNA MCR SUPP - Q5114","ZZZAETNA - ZZZAETNA MCR SUPP - Q5114 - PR INJ OGIVRI 10 MG","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",2163.34,1083.55,420.34,1838.84,540.84]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J1815","ZZZAETNA - ZZZAETNA POS - J1815","ZZZAETNA - ZZZAETNA POS - J1815 - PR INSULIN INJECTION","ZZZAETNA","ZZZAETNA POS","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,7.38,5.0199999999999996,456.36,3.49]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J2001","ZZZAETNA - ZZZAETNA POS - J2001","ZZZAETNA - ZZZAETNA POS - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.51,1.03,456.36,0.71]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3490","ZZZAETNA - ZZZAETNA POS - J3490","ZZZAETNA - ZZZAETNA POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZAETNA","ZZZAETNA POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,16.73,11.38,456.36,7.91]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J0690","ZZZAETNA - ZZZAETNA PPO-EPO - J0690","ZZZAETNA - ZZZAETNA PPO-EPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.72,1.17,456.36,0.81]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1815","ZZZAETNA - ZZZAETNA PPO-EPO - J1815","ZZZAETNA - ZZZAETNA PPO-EPO - J1815 - PR INSULIN INJECTION","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,6.68,4.55,456.36,3.16]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1953","ZZZAETNA - ZZZAETNA PPO-EPO - J1953","ZZZAETNA - ZZZAETNA PPO-EPO - J1953 - PR LEVETIRACETAM INJECTION","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,19.739999999999998,3.5,456.36,9.33]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2919","ZZZAETNA - ZZZAETNA PPO-EPO - J2919","ZZZAETNA - ZZZAETNA PPO-EPO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,6.91,4.71,456.36,3.27]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J0690","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J0690","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,11,3.16,456.36,5.2]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1561","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J1561","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J1561 - PR GAMUNEX-C/GAMMAKED","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,2455.46,420.34,3945.45,1160.43]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2001","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J2001","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.43,0.03,456.36,0.2]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J3490","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J3490","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,9.4,6.4,456.36,4.4400000000000004]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J1170","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J1170","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J1170 - PR HYDROMORPHONE INJECTION","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,0.83,0.7,456.36,0.49]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J2001","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J2001","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J2001 - PR LIDOCAINE INJECTION","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.35,0.03,456.36,0.2]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J2704","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J2704","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,32.799999999999997,13,456.36,19.190000000000001]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J7121","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J7121","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,9.11,3.84,456.36,5.33]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J1170","ZZZCCA ONECARE - ZZZCCA ONECARE - J1170","ZZZCCA ONECARE - ZZZCCA ONECARE - J1170 - PR HYDROMORPHONE INJECTION","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,222.04,61.88,456.36,55.51]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2704","ZZZCCA ONECARE - ZZZCCA ONECARE - J2704","ZZZCCA ONECARE - ZZZCCA ONECARE - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J3490","ZZZCCA ONECARE - ZZZCCA ONECARE - J3490","ZZZCCA ONECARE - ZZZCCA ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - S0020","ZZZCCA ONECARE - ZZZCCA ONECARE - S0020","ZZZCCA ONECARE - ZZZCCA ONECARE - S0020 - PR INJECTION, BUPIVICAINE HYDRO","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J1580","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J1580","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,369.46,2.78,456.36,92.37]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J2001","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J2001","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J2001 - PR LIDOCAINE INJECTION","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J7131","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J7131","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J7131 - PR HYPERTONIC SALINE SOL","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J0690","ZZZCIGNA - CIGNA LOCALPLUS - J0690","ZZZCIGNA - CIGNA LOCALPLUS - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,11.04,4.32,456.36,3.25]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2001","ZZZCIGNA - CIGNA LOCALPLUS - J2001","ZZZCIGNA - CIGNA LOCALPLUS - J2001 - PR LIDOCAINE INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.57999999999999996,0.06,456.36,0.17]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J3490","ZZZCIGNA - CIGNA LOCALPLUS - J3490","ZZZCIGNA - CIGNA LOCALPLUS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,26.88,11.38,456.36,7.91]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J0690","ZZZCIGNA - ZZZCIGNA CARELINK - J0690","ZZZCIGNA - ZZZCIGNA CARELINK - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1561","ZZZCIGNA - ZZZCIGNA CARELINK - J1561","ZZZCIGNA - ZZZCIGNA CARELINK - J1561 - PR GAMUNEX-C/GAMMAKED","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,1949.93,420.34,3945.45,1160.43]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2704","ZZZCIGNA - ZZZCIGNA CARELINK - J2704","ZZZCIGNA - ZZZCIGNA CARELINK - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2919","ZZZCIGNA - ZZZCIGNA CARELINK - J2919","ZZZCIGNA - ZZZCIGNA CARELINK - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,5.95,4.71,456.36,3.27]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J9041","ZZZCIGNA - ZZZCIGNA CARELINK - J9041","ZZZCIGNA - ZZZCIGNA CARELINK - J9041 - PR INJ., VELCADE 0.1 MG","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,941.9,68.569999999999993,4840.46,1423.67]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1953","ZZZCIGNA - ZZZCIGNA STANDARD - J1953","ZZZCIGNA - ZZZCIGNA STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,31.71,3.5,456.36,9.33]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2704","ZZZCIGNA - ZZZCIGNA STANDARD - J2704","ZZZCIGNA - ZZZCIGNA STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,42.28,2.15,456.36,12.44]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J3490","ZZZCIGNA - ZZZCIGNA STANDARD - J3490","ZZZCIGNA - ZZZCIGNA STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,0.96,0.41,456.36,0.28000000000000003]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J1170","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J1170","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J1170 - PR HYDROMORPHONE INJECTION","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.34,0.56999999999999995,0.48,456.36,0.34]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J1953","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J1953","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J1953 - PR LEVETIRACETAM INJECTION","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,22.02,10.5,456.36,12.88]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2704","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J2704","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J7131","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J7131","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J7131 - PR HYPERTONIC SALINE SOL","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,6.79,5.72,456.36,3.97]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J0736","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J0736","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2001","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J2001","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J2001 - PR LIDOCAINE INJECTION","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2704","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J2704","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1170","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J1170","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J1170 - PR HYDROMORPHONE INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",444.07,444.07,23.8,456.36,111.02]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1953","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J1953","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J1953 - PR LEVETIRACETAM INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J3490","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J3490","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,8.89,6.4,456.36,4.4400000000000004]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J1170","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J1170","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J1170 - PR HYDROMORPHONE INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J2001","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J2001","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J2001 - PR LIDOCAINE INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J2704","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J2704","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J2704 - PR INJ, PROPFOL, 10 MG","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J0137","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J0137","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.66]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J1580","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J1580","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J2310","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J2310","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J0690","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J0690","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81]
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["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2704","ZZZUNITED - ZZZUNITED DEFINITY HRA - J2704","ZZZUNITED - ZZZUNITED DEFINITY HRA - J2704 - PR INJ, PROPFOL, 10 MG","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61]
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["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J1953","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - J1953","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65]
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["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J2001","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - J2001","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - J2001 - PR LIDOCAINE INJECTION","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,9.24,2.78,456.36,2.31]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,369.46,2.78,456.36,92.37]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,35.5,2.78,456.36,8.8800000000000008]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,11.37,4.09,456.36,2.84]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,10.130000000000001,3.65,456.36,2.5299999999999998]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580","ZZZUNITED - ZZZUNITED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815","ZZZUNITED - ZZZUNITED STANDARD - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED - ZZZUNITED STANDARD - J2001","ZZZUNITED - ZZZUNITED STANDARD - J2001 - PR LIDOCAINE INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7121","ZZZUNITED - ZZZUNITED STANDARD - J7121","ZZZUNITED - ZZZUNITED STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,10.66,3.84,456.36,2.67]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7121","ZZZUNITED - ZZZUNITED STANDARD - J7121","ZZZUNITED - ZZZUNITED STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",12.44,12.44,4.4800000000000004,456.36,3.11]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131","ZZZUNITED - ZZZUNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J8540","ZZZUNITED - ZZZUNITED STANDARD - J8540","ZZZUNITED - ZZZUNITED STANDARD - J8540 - PR ORAL DEXAMETHASONE","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - P9047","ZZZUNITED - ZZZUNITED STANDARD - P9047","ZZZUNITED - ZZZUNITED STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,138.30000000000001,50.13,456.36,46.75]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q0249","ZZZUNITED - ZZZUNITED STANDARD - Q0249","ZZZUNITED - ZZZUNITED STANDARD - Q0249 - TOCILIZUMAB FOR COVID-19","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,9,3.24,456.36,2.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q5114","ZZZUNITED - ZZZUNITED STANDARD - Q5114","ZZZUNITED - ZZZUNITED STANDARD - Q5114 - PR INJ OGIVRI 10 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",2163.34,710.85,420.34,1838.84,540.84]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q5114","ZZZUNITED - ZZZUNITED STANDARD - Q5114","ZZZUNITED - ZZZUNITED STANDARD - Q5114 - PR INJ OGIVRI 10 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q5114","ZZZUNITED - ZZZUNITED STANDARD - Q5114","ZZZUNITED - ZZZUNITED STANDARD - Q5114 - PR INJ OGIVRI 10 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q5114","ZZZUNITED - ZZZUNITED STANDARD - Q5114","ZZZUNITED - ZZZUNITED STANDARD - Q5114 - PR INJ OGIVRI 10 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",35,35,0.12,456.36,8.75]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,116,0.12,456.36,29]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - S0020","ZZZUNITED - ZZZUNITED STANDARD - S0020","ZZZUNITED - ZZZUNITED STANDARD - S0020 - PR INJECTION, BUPIVICAINE HYDRO","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]

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["Payer – Plan – Bill Type – Bill Code","Payer","Plan","Bill Type","Bill Code","Billing Description","Bill Code & Description","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge","Duplicates"]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 19120","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 29881","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 43235","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 43239","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45380","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45385","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45391","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 55700","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 55700","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62322","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62322","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62323","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 64483","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 66821","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 66984","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70450","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70553","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70553","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72110","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72148","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72193","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 73721","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 74177","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76700","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76700","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76805","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76805","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76830","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76830","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77065","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77066","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77067","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80048","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80053","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80055","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80061","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80069","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80076","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81000","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81000","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81002","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81002","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81003","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81003","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 84153","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 84443","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85025","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85027","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85610","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85610","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85730","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85730","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90662","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90686","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90715","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90832","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90834","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90837","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90846","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90847","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90853","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 93452","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 95810","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 97110","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99203","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99203","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99204","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99204","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99205","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99205","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99212","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99212","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99213","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99213","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99214","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99214","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99215","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99215","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9500","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9513","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9517","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9552","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9555","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9575","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9579","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9579","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9581","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - J1030","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - J3301","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - P9047","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9958","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9963","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9963","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9966","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 19120","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 29881","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 43235","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 43239","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45380","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45385","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45391","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 55700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 55700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62322","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62322","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62323","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 64483","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 66821","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 66984","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70450","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70553","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70553","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72110","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72148","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72193","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 73721","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 74177","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76805","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76805","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76830","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76830","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77065","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77066","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77067","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80048","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80053","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80055","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80061","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80069","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80076","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81000","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81000","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81002","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81002","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81003","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81003","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 84153","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 84443","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85025","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85027","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85610","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85610","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85730","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85730","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90662","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90686","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90715","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90832","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90834","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90837","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90846","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90847","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90853","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 93452","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 95810","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 97110","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99203","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99203","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99204","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99204","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99205","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99205","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99212","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99212","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99213","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99213","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99214","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99214","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99215","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99215","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9500","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9513","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9517","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9552","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9555","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9575","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9579","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9579","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9581","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - J1030","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - J3301","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - P9047","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9958","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9963","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9963","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9966","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 19120","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 29881","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 43235","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 43239","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45380","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45385","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45391","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 55700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 55700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62322","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62322","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62323","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 64483","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 66821","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 66984","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70450","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70553","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70553","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72110","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72148","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72193","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 73721","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 74177","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76805","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76805","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76830","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76830","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77065","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77066","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77067","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80048","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80053","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80055","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80061","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80069","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80076","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81000","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81000","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81002","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81002","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81003","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81003","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 84153","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 84443","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85025","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85027","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85610","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85610","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85730","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85730","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90662","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90686","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90715","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90832","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90834","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90837","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90846","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90847","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90853","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 93452","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 95810","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 97110","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99203","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99203","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99204","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99204","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99205","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99205","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99212","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99212","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99213","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99213","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99214","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99214","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99215","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99215","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9500","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9513","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9517","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9552","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9555","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9575","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9579","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9579","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9581","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - J1030","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - J3301","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - P9047","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9958","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9963","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9963","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9966","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 19120","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 29881","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43235","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43239","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45380","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45385","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45391","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 55700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 55700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62322","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62322","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62323","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 64483","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 66821","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 66984","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70450","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70553","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70553","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72110","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72148","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72193","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 73721","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 74177","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76700","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76805","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76805","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76830","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76830","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77065","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77066","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77067","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80048","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80053","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80055","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80061","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80069","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80076","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81000","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81000","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81002","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81002","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81003","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81003","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 84153","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 84443","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85025","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85027","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85610","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85610","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85730","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85730","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90662","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90686","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90715","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90832","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90834","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90837","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90846","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90847","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90853","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 93452","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 95810","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 97110","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99203","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99203","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99204","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99204","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99205","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99205","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99212","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99212","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99213","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99213","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99214","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99214","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99215","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99215","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9500","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9513","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9517","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9552","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9555","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9575","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9579","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9579","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9581","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - J1030","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - J3301","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - P9047","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9958","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9963","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9963","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9966","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - 19120","AETNA","AETNA HMO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75,1]
["AETNA - AETNA HMO - CPT - 29881","AETNA","AETNA HMO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5,1]
["AETNA - AETNA HMO - CPT - 43235","AETNA","AETNA HMO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25,1]
["AETNA - AETNA HMO - CPT - 43239","AETNA","AETNA HMO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428,1]
["AETNA - AETNA HMO - CPT - 45378","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA HMO - CPT - 45378","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA HMO - CPT - 45378","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA HMO - CPT - 45380","AETNA","AETNA HMO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75,1]
["AETNA - AETNA HMO - CPT - 45385","AETNA","AETNA HMO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760,1]
["AETNA - AETNA HMO - CPT - 45391","AETNA","AETNA HMO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731,1]
["AETNA - AETNA HMO - CPT - 55700","AETNA","AETNA HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA HMO - CPT - 55700","AETNA","AETNA HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA HMO - CPT - 62322","AETNA","AETNA HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA HMO - CPT - 62322","AETNA","AETNA HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA HMO - CPT - 62323","AETNA","AETNA HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25,1]
["AETNA - AETNA HMO - CPT - 64483","AETNA","AETNA HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25,1]
["AETNA - AETNA HMO - CPT - 66821","AETNA","AETNA HMO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75,1]
["AETNA - AETNA HMO - CPT - 66984","AETNA","AETNA HMO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556,1]
["AETNA - AETNA HMO - CPT - 70450","AETNA","AETNA HMO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5,1]
["AETNA - AETNA HMO - CPT - 70553","AETNA","AETNA HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA HMO - CPT - 70553","AETNA","AETNA HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA HMO - CPT - 72110","AETNA","AETNA HMO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75,1]
["AETNA - AETNA HMO - CPT - 72148","AETNA","AETNA HMO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25,1]
["AETNA - AETNA HMO - CPT - 72193","AETNA","AETNA HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760,1]
["AETNA - AETNA HMO - CPT - 73721","AETNA","AETNA HMO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266,1]
["AETNA - AETNA HMO - CPT - 74177","AETNA","AETNA HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75,1]
["AETNA - AETNA HMO - CPT - 76700","AETNA","AETNA HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA HMO - CPT - 76700","AETNA","AETNA HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA HMO - CPT - 76805","AETNA","AETNA HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA HMO - CPT - 76805","AETNA","AETNA HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA HMO - CPT - 76830","AETNA","AETNA HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA HMO - CPT - 76830","AETNA","AETNA HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA HMO - CPT - 77065","AETNA","AETNA HMO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188,1]
["AETNA - AETNA HMO - CPT - 77066","AETNA","AETNA HMO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231,1]
["AETNA - AETNA HMO - CPT - 77067","AETNA","AETNA HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122,1]
["AETNA - AETNA HMO - CPT - 80048","AETNA","AETNA HMO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75,1]
["AETNA - AETNA HMO - CPT - 80053","AETNA","AETNA HMO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75,1]
["AETNA - AETNA HMO - CPT - 80055","AETNA","AETNA HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65,1]
["AETNA - AETNA HMO - CPT - 80061","AETNA","AETNA HMO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25,1]
["AETNA - AETNA HMO - CPT - 80069","AETNA","AETNA HMO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75,1]
["AETNA - AETNA HMO - CPT - 80076","AETNA","AETNA HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75,1]
["AETNA - AETNA HMO - CPT - 81000","AETNA","AETNA HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA HMO - CPT - 81000","AETNA","AETNA HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA HMO - CPT - 81001","AETNA","AETNA HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6,1]
["AETNA - AETNA HMO - CPT - 81002","AETNA","AETNA HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA HMO - CPT - 81002","AETNA","AETNA HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA HMO - CPT - 81003","AETNA","AETNA HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA HMO - CPT - 81003","AETNA","AETNA HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA HMO - CPT - 84153","AETNA","AETNA HMO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25,1]
["AETNA - AETNA HMO - CPT - 84443","AETNA","AETNA HMO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5,1]
["AETNA - AETNA HMO - CPT - 85025","AETNA","AETNA HMO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75,1]
["AETNA - AETNA HMO - CPT - 85027","AETNA","AETNA HMO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25,1]
["AETNA - AETNA HMO - CPT - 85610","AETNA","AETNA HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA HMO - CPT - 85610","AETNA","AETNA HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA HMO - CPT - 85730","AETNA","AETNA HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA HMO - CPT - 85730","AETNA","AETNA HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA HMO - CPT - 90662","AETNA","AETNA HMO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25,1]
["AETNA - AETNA HMO - CPT - 90686","AETNA","AETNA HMO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5,1]
["AETNA - AETNA HMO - CPT - 90715","AETNA","AETNA HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45,1]
["AETNA - AETNA HMO - CPT - 90832","AETNA","AETNA HMO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42,1]
["AETNA - AETNA HMO - CPT - 90834","AETNA","AETNA HMO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA HMO - CPT - 90837","AETNA","AETNA HMO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA HMO - CPT - 90846","AETNA","AETNA HMO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77,1]
["AETNA - AETNA HMO - CPT - 90847","AETNA","AETNA HMO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75,1]
["AETNA - AETNA HMO - CPT - 90853","AETNA","AETNA HMO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25,1]
["AETNA - AETNA HMO - CPT - 93452","AETNA","AETNA HMO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5,1]
["AETNA - AETNA HMO - CPT - 95810","AETNA","AETNA HMO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75,1]
["AETNA - AETNA HMO - CPT - 97110","AETNA","AETNA HMO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25,1]
["AETNA - AETNA HMO - CPT - 99203","AETNA","AETNA HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA HMO - CPT - 99203","AETNA","AETNA HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA HMO - CPT - 99204","AETNA","AETNA HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA HMO - CPT - 99204","AETNA","AETNA HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA HMO - CPT - 99205","AETNA","AETNA HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA HMO - CPT - 99205","AETNA","AETNA HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA HMO - CPT - 99212","AETNA","AETNA HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA HMO - CPT - 99212","AETNA","AETNA HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA HMO - CPT - 99213","AETNA","AETNA HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA HMO - CPT - 99213","AETNA","AETNA HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA HMO - CPT - 99214","AETNA","AETNA HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA HMO - CPT - 99214","AETNA","AETNA HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA HMO - CPT - 99215","AETNA","AETNA HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA HMO - CPT - 99215","AETNA","AETNA HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA HMO - CPT - 99385","AETNA","AETNA HMO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5,1]
["AETNA - AETNA HMO - CPT - 99386","AETNA","AETNA HMO","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160,1]
["AETNA - AETNA HMO - CPT - A9500","AETNA","AETNA HMO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["AETNA - AETNA HMO - CPT - A9513","AETNA","AETNA HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25,1]
["AETNA - AETNA HMO - CPT - A9517","AETNA","AETNA HMO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75,1]
["AETNA - AETNA HMO - CPT - A9552","AETNA","AETNA HMO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["AETNA - AETNA HMO - CPT - A9555","AETNA","AETNA HMO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["AETNA - AETNA HMO - CPT - A9575","AETNA","AETNA HMO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["AETNA - AETNA HMO - CPT - A9579","AETNA","AETNA HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["AETNA - AETNA HMO - CPT - A9579","AETNA","AETNA HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["AETNA - AETNA HMO - CPT - A9581","AETNA","AETNA HMO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["AETNA - AETNA HMO - CPT - J1030","AETNA","AETNA HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25,1]
["AETNA - AETNA HMO - CPT - J3301","AETNA","AETNA HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5,1]
["AETNA - AETNA HMO - CPT - P9047","AETNA","AETNA HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45,1]
["AETNA - AETNA HMO - CPT - Q9958","AETNA","AETNA HMO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9963","AETNA","AETNA HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9963","AETNA","AETNA HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9966","AETNA","AETNA HMO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA HMO - CPT - Q9967","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - 19120","AETNA","AETNA MCR SUPP","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75,1]
["AETNA - AETNA MCR SUPP - CPT - 29881","AETNA","AETNA MCR SUPP","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5,1]
["AETNA - AETNA MCR SUPP - CPT - 43235","AETNA","AETNA MCR SUPP","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25,1]
["AETNA - AETNA MCR SUPP - CPT - 43239","AETNA","AETNA MCR SUPP","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428,1]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA MCR SUPP - CPT - 45380","AETNA","AETNA MCR SUPP","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75,1]
["AETNA - AETNA MCR SUPP - CPT - 45385","AETNA","AETNA MCR SUPP","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760,1]
["AETNA - AETNA MCR SUPP - CPT - 45391","AETNA","AETNA MCR SUPP","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731,1]
["AETNA - AETNA MCR SUPP - CPT - 55700","AETNA","AETNA MCR SUPP","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA MCR SUPP - CPT - 55700","AETNA","AETNA MCR SUPP","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA MCR SUPP - CPT - 62322","AETNA","AETNA MCR SUPP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA MCR SUPP - CPT - 62322","AETNA","AETNA MCR SUPP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA MCR SUPP - CPT - 62323","AETNA","AETNA MCR SUPP","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25,1]
["AETNA - AETNA MCR SUPP - CPT - 64483","AETNA","AETNA MCR SUPP","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25,1]
["AETNA - AETNA MCR SUPP - CPT - 66821","AETNA","AETNA MCR SUPP","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75,1]
["AETNA - AETNA MCR SUPP - CPT - 66984","AETNA","AETNA MCR SUPP","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556,1]
["AETNA - AETNA MCR SUPP - CPT - 70450","AETNA","AETNA MCR SUPP","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5,1]
["AETNA - AETNA MCR SUPP - CPT - 70553","AETNA","AETNA MCR SUPP","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA MCR SUPP - CPT - 70553","AETNA","AETNA MCR SUPP","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA MCR SUPP - CPT - 72110","AETNA","AETNA MCR SUPP","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75,1]
["AETNA - AETNA MCR SUPP - CPT - 72148","AETNA","AETNA MCR SUPP","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25,1]
["AETNA - AETNA MCR SUPP - CPT - 72193","AETNA","AETNA MCR SUPP","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760,1]
["AETNA - AETNA MCR SUPP - CPT - 73721","AETNA","AETNA MCR SUPP","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266,1]
["AETNA - AETNA MCR SUPP - CPT - 74177","AETNA","AETNA MCR SUPP","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75,1]
["AETNA - AETNA MCR SUPP - CPT - 76700","AETNA","AETNA MCR SUPP","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA MCR SUPP - CPT - 76700","AETNA","AETNA MCR SUPP","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA MCR SUPP - CPT - 76805","AETNA","AETNA MCR SUPP","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA MCR SUPP - CPT - 76805","AETNA","AETNA MCR SUPP","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA MCR SUPP - CPT - 76830","AETNA","AETNA MCR SUPP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA MCR SUPP - CPT - 76830","AETNA","AETNA MCR SUPP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA MCR SUPP - CPT - 77065","AETNA","AETNA MCR SUPP","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188,1]
["AETNA - AETNA MCR SUPP - CPT - 77066","AETNA","AETNA MCR SUPP","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231,1]
["AETNA - AETNA MCR SUPP - CPT - 77067","AETNA","AETNA MCR SUPP","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122,1]
["AETNA - AETNA MCR SUPP - CPT - 80048","AETNA","AETNA MCR SUPP","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75,1]
["AETNA - AETNA MCR SUPP - CPT - 80053","AETNA","AETNA MCR SUPP","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75,1]
["AETNA - AETNA MCR SUPP - CPT - 80055","AETNA","AETNA MCR SUPP","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65,1]
["AETNA - AETNA MCR SUPP - CPT - 80061","AETNA","AETNA MCR SUPP","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25,1]
["AETNA - AETNA MCR SUPP - CPT - 80069","AETNA","AETNA MCR SUPP","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75,1]
["AETNA - AETNA MCR SUPP - CPT - 80076","AETNA","AETNA MCR SUPP","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75,1]
["AETNA - AETNA MCR SUPP - CPT - 81000","AETNA","AETNA MCR SUPP","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA MCR SUPP - CPT - 81000","AETNA","AETNA MCR SUPP","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA MCR SUPP - CPT - 81001","AETNA","AETNA MCR SUPP","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6,1]
["AETNA - AETNA MCR SUPP - CPT - 81002","AETNA","AETNA MCR SUPP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA MCR SUPP - CPT - 81002","AETNA","AETNA MCR SUPP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA MCR SUPP - CPT - 81003","AETNA","AETNA MCR SUPP","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA MCR SUPP - CPT - 81003","AETNA","AETNA MCR SUPP","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA MCR SUPP - CPT - 84153","AETNA","AETNA MCR SUPP","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25,1]
["AETNA - AETNA MCR SUPP - CPT - 84443","AETNA","AETNA MCR SUPP","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5,1]
["AETNA - AETNA MCR SUPP - CPT - 85025","AETNA","AETNA MCR SUPP","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75,1]
["AETNA - AETNA MCR SUPP - CPT - 85027","AETNA","AETNA MCR SUPP","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25,1]
["AETNA - AETNA MCR SUPP - CPT - 85610","AETNA","AETNA MCR SUPP","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA MCR SUPP - CPT - 85610","AETNA","AETNA MCR SUPP","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA MCR SUPP - CPT - 85730","AETNA","AETNA MCR SUPP","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA MCR SUPP - CPT - 85730","AETNA","AETNA MCR SUPP","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA MCR SUPP - CPT - 90662","AETNA","AETNA MCR SUPP","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25,1]
["AETNA - AETNA MCR SUPP - CPT - 90686","AETNA","AETNA MCR SUPP","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5,1]
["AETNA - AETNA MCR SUPP - CPT - 90715","AETNA","AETNA MCR SUPP","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45,1]
["AETNA - AETNA MCR SUPP - CPT - 90832","AETNA","AETNA MCR SUPP","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42,1]
["AETNA - AETNA MCR SUPP - CPT - 90834","AETNA","AETNA MCR SUPP","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA MCR SUPP - CPT - 90837","AETNA","AETNA MCR SUPP","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA MCR SUPP - CPT - 90846","AETNA","AETNA MCR SUPP","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77,1]
["AETNA - AETNA MCR SUPP - CPT - 90847","AETNA","AETNA MCR SUPP","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75,1]
["AETNA - AETNA MCR SUPP - CPT - 90853","AETNA","AETNA MCR SUPP","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25,1]
["AETNA - AETNA MCR SUPP - CPT - 93452","AETNA","AETNA MCR SUPP","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5,1]
["AETNA - AETNA MCR SUPP - CPT - 95810","AETNA","AETNA MCR SUPP","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75,1]
["AETNA - AETNA MCR SUPP - CPT - 97110","AETNA","AETNA MCR SUPP","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25,1]
["AETNA - AETNA MCR SUPP - CPT - 99203","AETNA","AETNA MCR SUPP","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA MCR SUPP - CPT - 99203","AETNA","AETNA MCR SUPP","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA MCR SUPP - CPT - 99204","AETNA","AETNA MCR SUPP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA MCR SUPP - CPT - 99204","AETNA","AETNA MCR SUPP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA MCR SUPP - CPT - 99205","AETNA","AETNA MCR SUPP","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA MCR SUPP - CPT - 99205","AETNA","AETNA MCR SUPP","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA MCR SUPP - CPT - 99212","AETNA","AETNA MCR SUPP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA MCR SUPP - CPT - 99212","AETNA","AETNA MCR SUPP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA MCR SUPP - CPT - 99213","AETNA","AETNA MCR SUPP","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA MCR SUPP - CPT - 99213","AETNA","AETNA MCR SUPP","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA MCR SUPP - CPT - 99214","AETNA","AETNA MCR SUPP","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA MCR SUPP - CPT - 99214","AETNA","AETNA MCR SUPP","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA MCR SUPP - CPT - 99215","AETNA","AETNA MCR SUPP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA MCR SUPP - CPT - 99215","AETNA","AETNA MCR SUPP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA MCR SUPP - CPT - 99385","AETNA","AETNA MCR SUPP","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5,1]
["AETNA - AETNA MCR SUPP - CPT - 99386","AETNA","AETNA MCR SUPP","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160,1]
["AETNA - AETNA MCR SUPP - CPT - A9500","AETNA","AETNA MCR SUPP","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["AETNA - AETNA MCR SUPP - CPT - A9513","AETNA","AETNA MCR SUPP","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25,1]
["AETNA - AETNA MCR SUPP - CPT - A9517","AETNA","AETNA MCR SUPP","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75,1]
["AETNA - AETNA MCR SUPP - CPT - A9552","AETNA","AETNA MCR SUPP","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["AETNA - AETNA MCR SUPP - CPT - A9555","AETNA","AETNA MCR SUPP","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["AETNA - AETNA MCR SUPP - CPT - A9575","AETNA","AETNA MCR SUPP","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["AETNA - AETNA MCR SUPP - CPT - A9579","AETNA","AETNA MCR SUPP","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["AETNA - AETNA MCR SUPP - CPT - A9579","AETNA","AETNA MCR SUPP","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["AETNA - AETNA MCR SUPP - CPT - A9581","AETNA","AETNA MCR SUPP","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["AETNA - AETNA MCR SUPP - CPT - J1030","AETNA","AETNA MCR SUPP","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25,1]
["AETNA - AETNA MCR SUPP - CPT - J3301","AETNA","AETNA MCR SUPP","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5,1]
["AETNA - AETNA MCR SUPP - CPT - P9047","AETNA","AETNA MCR SUPP","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45,1]
["AETNA - AETNA MCR SUPP - CPT - Q9958","AETNA","AETNA MCR SUPP","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9963","AETNA","AETNA MCR SUPP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9963","AETNA","AETNA MCR SUPP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9966","AETNA","AETNA MCR SUPP","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA POS - CPT - 19120","AETNA","AETNA POS","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75,1]
["AETNA - AETNA POS - CPT - 29881","AETNA","AETNA POS","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5,1]
["AETNA - AETNA POS - CPT - 43235","AETNA","AETNA POS","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25,1]
["AETNA - AETNA POS - CPT - 43239","AETNA","AETNA POS","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428,1]
["AETNA - AETNA POS - CPT - 45378","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA POS - CPT - 45378","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA POS - CPT - 45378","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA POS - CPT - 45380","AETNA","AETNA POS","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75,1]
["AETNA - AETNA POS - CPT - 45385","AETNA","AETNA POS","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760,1]
["AETNA - AETNA POS - CPT - 45391","AETNA","AETNA POS","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731,1]
["AETNA - AETNA POS - CPT - 55700","AETNA","AETNA POS","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA POS - CPT - 55700","AETNA","AETNA POS","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA POS - CPT - 62322","AETNA","AETNA POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA POS - CPT - 62322","AETNA","AETNA POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA POS - CPT - 62323","AETNA","AETNA POS","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25,1]
["AETNA - AETNA POS - CPT - 64483","AETNA","AETNA POS","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25,1]
["AETNA - AETNA POS - CPT - 66821","AETNA","AETNA POS","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75,1]
["AETNA - AETNA POS - CPT - 66984","AETNA","AETNA POS","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556,1]
["AETNA - AETNA POS - CPT - 70450","AETNA","AETNA POS","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5,1]
["AETNA - AETNA POS - CPT - 70553","AETNA","AETNA POS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA POS - CPT - 70553","AETNA","AETNA POS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA POS - CPT - 72110","AETNA","AETNA POS","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75,1]
["AETNA - AETNA POS - CPT - 72148","AETNA","AETNA POS","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25,1]
["AETNA - AETNA POS - CPT - 72193","AETNA","AETNA POS","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760,1]
["AETNA - AETNA POS - CPT - 73721","AETNA","AETNA POS","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266,1]
["AETNA - AETNA POS - CPT - 74177","AETNA","AETNA POS","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75,1]
["AETNA - AETNA POS - CPT - 76700","AETNA","AETNA POS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA POS - CPT - 76700","AETNA","AETNA POS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA POS - CPT - 76805","AETNA","AETNA POS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA POS - CPT - 76805","AETNA","AETNA POS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA POS - CPT - 76830","AETNA","AETNA POS","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA POS - CPT - 76830","AETNA","AETNA POS","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA POS - CPT - 77065","AETNA","AETNA POS","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188,1]
["AETNA - AETNA POS - CPT - 77066","AETNA","AETNA POS","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231,1]
["AETNA - AETNA POS - CPT - 77067","AETNA","AETNA POS","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122,1]
["AETNA - AETNA POS - CPT - 80048","AETNA","AETNA POS","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75,1]
["AETNA - AETNA POS - CPT - 80053","AETNA","AETNA POS","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75,1]
["AETNA - AETNA POS - CPT - 80055","AETNA","AETNA POS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65,1]
["AETNA - AETNA POS - CPT - 80061","AETNA","AETNA POS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25,1]
["AETNA - AETNA POS - CPT - 80069","AETNA","AETNA POS","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75,1]
["AETNA - AETNA POS - CPT - 80076","AETNA","AETNA POS","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75,1]
["AETNA - AETNA POS - CPT - 81000","AETNA","AETNA POS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA POS - CPT - 81000","AETNA","AETNA POS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA POS - CPT - 81001","AETNA","AETNA POS","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6,1]
["AETNA - AETNA POS - CPT - 81002","AETNA","AETNA POS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA POS - CPT - 81002","AETNA","AETNA POS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA POS - CPT - 81003","AETNA","AETNA POS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA POS - CPT - 81003","AETNA","AETNA POS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA POS - CPT - 84153","AETNA","AETNA POS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25,1]
["AETNA - AETNA POS - CPT - 84443","AETNA","AETNA POS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5,1]
["AETNA - AETNA POS - CPT - 85025","AETNA","AETNA POS","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75,1]
["AETNA - AETNA POS - CPT - 85027","AETNA","AETNA POS","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25,1]
["AETNA - AETNA POS - CPT - 85610","AETNA","AETNA POS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA POS - CPT - 85610","AETNA","AETNA POS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA POS - CPT - 85730","AETNA","AETNA POS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA POS - CPT - 85730","AETNA","AETNA POS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA POS - CPT - 90662","AETNA","AETNA POS","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25,1]
["AETNA - AETNA POS - CPT - 90686","AETNA","AETNA POS","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5,1]
["AETNA - AETNA POS - CPT - 90715","AETNA","AETNA POS","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45,1]
["AETNA - AETNA POS - CPT - 90832","AETNA","AETNA POS","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42,1]
["AETNA - AETNA POS - CPT - 90834","AETNA","AETNA POS","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA POS - CPT - 90837","AETNA","AETNA POS","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA POS - CPT - 90846","AETNA","AETNA POS","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77,1]
["AETNA - AETNA POS - CPT - 90847","AETNA","AETNA POS","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75,1]
["AETNA - AETNA POS - CPT - 90853","AETNA","AETNA POS","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25,1]
["AETNA - AETNA POS - CPT - 93452","AETNA","AETNA POS","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5,1]
["AETNA - AETNA POS - CPT - 95810","AETNA","AETNA POS","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75,1]
["AETNA - AETNA POS - CPT - 97110","AETNA","AETNA POS","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25,1]
["AETNA - AETNA POS - CPT - 99203","AETNA","AETNA POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA POS - CPT - 99203","AETNA","AETNA POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA POS - CPT - 99204","AETNA","AETNA POS","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA POS - CPT - 99204","AETNA","AETNA POS","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA POS - CPT - 99205","AETNA","AETNA POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA POS - CPT - 99205","AETNA","AETNA POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA POS - CPT - 99212","AETNA","AETNA POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA POS - CPT - 99212","AETNA","AETNA POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA POS - CPT - 99213","AETNA","AETNA POS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA POS - CPT - 99213","AETNA","AETNA POS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA POS - CPT - 99214","AETNA","AETNA POS","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA POS - CPT - 99214","AETNA","AETNA POS","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA POS - CPT - 99215","AETNA","AETNA POS","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA POS - CPT - 99215","AETNA","AETNA POS","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA POS - CPT - 99385","AETNA","AETNA POS","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5,1]
["AETNA - AETNA POS - CPT - 99386","AETNA","AETNA POS","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160,1]
["AETNA - AETNA POS - CPT - A9500","AETNA","AETNA POS","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["AETNA - AETNA POS - CPT - A9513","AETNA","AETNA POS","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25,1]
["AETNA - AETNA POS - CPT - A9517","AETNA","AETNA POS","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75,1]
["AETNA - AETNA POS - CPT - A9552","AETNA","AETNA POS","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["AETNA - AETNA POS - CPT - A9555","AETNA","AETNA POS","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["AETNA - AETNA POS - CPT - A9575","AETNA","AETNA POS","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["AETNA - AETNA POS - CPT - A9579","AETNA","AETNA POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["AETNA - AETNA POS - CPT - A9579","AETNA","AETNA POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["AETNA - AETNA POS - CPT - A9581","AETNA","AETNA POS","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["AETNA - AETNA POS - CPT - J1030","AETNA","AETNA POS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25,1]
["AETNA - AETNA POS - CPT - J3301","AETNA","AETNA POS","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5,1]
["AETNA - AETNA POS - CPT - P9047","AETNA","AETNA POS","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45,1]
["AETNA - AETNA POS - CPT - Q9958","AETNA","AETNA POS","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9963","AETNA","AETNA POS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9963","AETNA","AETNA POS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9966","AETNA","AETNA POS","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA POS - CPT - Q9967","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AETNA - AETNA PPO EPO - CPT - 19120","AETNA","AETNA PPO EPO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75,1]
["AETNA - AETNA PPO EPO - CPT - 29881","AETNA","AETNA PPO EPO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5,1]
["AETNA - AETNA PPO EPO - CPT - 43235","AETNA","AETNA PPO EPO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25,1]
["AETNA - AETNA PPO EPO - CPT - 43239","AETNA","AETNA PPO EPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428,1]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["AETNA - AETNA PPO EPO - CPT - 45380","AETNA","AETNA PPO EPO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75,1]
["AETNA - AETNA PPO EPO - CPT - 45385","AETNA","AETNA PPO EPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760,1]
["AETNA - AETNA PPO EPO - CPT - 45391","AETNA","AETNA PPO EPO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731,1]
["AETNA - AETNA PPO EPO - CPT - 55700","AETNA","AETNA PPO EPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA PPO EPO - CPT - 55700","AETNA","AETNA PPO EPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA PPO EPO - CPT - 62322","AETNA","AETNA PPO EPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA PPO EPO - CPT - 62322","AETNA","AETNA PPO EPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA PPO EPO - CPT - 62323","AETNA","AETNA PPO EPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25,1]
["AETNA - AETNA PPO EPO - CPT - 64483","AETNA","AETNA PPO EPO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25,1]
["AETNA - AETNA PPO EPO - CPT - 66821","AETNA","AETNA PPO EPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75,1]
["AETNA - AETNA PPO EPO - CPT - 66984","AETNA","AETNA PPO EPO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556,1]
["AETNA - AETNA PPO EPO - CPT - 70450","AETNA","AETNA PPO EPO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5,1]
["AETNA - AETNA PPO EPO - CPT - 70553","AETNA","AETNA PPO EPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA PPO EPO - CPT - 70553","AETNA","AETNA PPO EPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA PPO EPO - CPT - 72110","AETNA","AETNA PPO EPO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75,1]
["AETNA - AETNA PPO EPO - CPT - 72148","AETNA","AETNA PPO EPO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25,1]
["AETNA - AETNA PPO EPO - CPT - 72193","AETNA","AETNA PPO EPO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760,1]
["AETNA - AETNA PPO EPO - CPT - 73721","AETNA","AETNA PPO EPO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266,1]
["AETNA - AETNA PPO EPO - CPT - 74177","AETNA","AETNA PPO EPO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75,1]
["AETNA - AETNA PPO EPO - CPT - 76700","AETNA","AETNA PPO EPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA PPO EPO - CPT - 76700","AETNA","AETNA PPO EPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA PPO EPO - CPT - 76805","AETNA","AETNA PPO EPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA PPO EPO - CPT - 76805","AETNA","AETNA PPO EPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA PPO EPO - CPT - 76830","AETNA","AETNA PPO EPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA PPO EPO - CPT - 76830","AETNA","AETNA PPO EPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA PPO EPO - CPT - 77065","AETNA","AETNA PPO EPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188,1]
["AETNA - AETNA PPO EPO - CPT - 77066","AETNA","AETNA PPO EPO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231,1]
["AETNA - AETNA PPO EPO - CPT - 77067","AETNA","AETNA PPO EPO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122,1]
["AETNA - AETNA PPO EPO - CPT - 80048","AETNA","AETNA PPO EPO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75,1]
["AETNA - AETNA PPO EPO - CPT - 80053","AETNA","AETNA PPO EPO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75,1]
["AETNA - AETNA PPO EPO - CPT - 80055","AETNA","AETNA PPO EPO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65,1]
["AETNA - AETNA PPO EPO - CPT - 80061","AETNA","AETNA PPO EPO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25,1]
["AETNA - AETNA PPO EPO - CPT - 80069","AETNA","AETNA PPO EPO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75,1]
["AETNA - AETNA PPO EPO - CPT - 80076","AETNA","AETNA PPO EPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75,1]
["AETNA - AETNA PPO EPO - CPT - 81000","AETNA","AETNA PPO EPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA PPO EPO - CPT - 81000","AETNA","AETNA PPO EPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA PPO EPO - CPT - 81001","AETNA","AETNA PPO EPO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6,1]
["AETNA - AETNA PPO EPO - CPT - 81002","AETNA","AETNA PPO EPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA PPO EPO - CPT - 81002","AETNA","AETNA PPO EPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA PPO EPO - CPT - 81003","AETNA","AETNA PPO EPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA PPO EPO - CPT - 81003","AETNA","AETNA PPO EPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA PPO EPO - CPT - 84153","AETNA","AETNA PPO EPO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25,1]
["AETNA - AETNA PPO EPO - CPT - 84443","AETNA","AETNA PPO EPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5,1]
["AETNA - AETNA PPO EPO - CPT - 85025","AETNA","AETNA PPO EPO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75,1]
["AETNA - AETNA PPO EPO - CPT - 85027","AETNA","AETNA PPO EPO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25,1]
["AETNA - AETNA PPO EPO - CPT - 85610","AETNA","AETNA PPO EPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA PPO EPO - CPT - 85610","AETNA","AETNA PPO EPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA PPO EPO - CPT - 85730","AETNA","AETNA PPO EPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA PPO EPO - CPT - 85730","AETNA","AETNA PPO EPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA PPO EPO - CPT - 90662","AETNA","AETNA PPO EPO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25,1]
["AETNA - AETNA PPO EPO - CPT - 90686","AETNA","AETNA PPO EPO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5,1]
["AETNA - AETNA PPO EPO - CPT - 90715","AETNA","AETNA PPO EPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45,1]
["AETNA - AETNA PPO EPO - CPT - 90832","AETNA","AETNA PPO EPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42,1]
["AETNA - AETNA PPO EPO - CPT - 90834","AETNA","AETNA PPO EPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA PPO EPO - CPT - 90837","AETNA","AETNA PPO EPO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA PPO EPO - CPT - 90846","AETNA","AETNA PPO EPO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77,1]
["AETNA - AETNA PPO EPO - CPT - 90847","AETNA","AETNA PPO EPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75,1]
["AETNA - AETNA PPO EPO - CPT - 90853","AETNA","AETNA PPO EPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25,1]
["AETNA - AETNA PPO EPO - CPT - 93452","AETNA","AETNA PPO EPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5,1]
["AETNA - AETNA PPO EPO - CPT - 95810","AETNA","AETNA PPO EPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75,1]
["AETNA - AETNA PPO EPO - CPT - 97110","AETNA","AETNA PPO EPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25,1]
["AETNA - AETNA PPO EPO - CPT - 99203","AETNA","AETNA PPO EPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA PPO EPO - CPT - 99203","AETNA","AETNA PPO EPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA PPO EPO - CPT - 99204","AETNA","AETNA PPO EPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA PPO EPO - CPT - 99204","AETNA","AETNA PPO EPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA PPO EPO - CPT - 99205","AETNA","AETNA PPO EPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA PPO EPO - CPT - 99205","AETNA","AETNA PPO EPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA PPO EPO - CPT - 99212","AETNA","AETNA PPO EPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA PPO EPO - CPT - 99212","AETNA","AETNA PPO EPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA PPO EPO - CPT - 99213","AETNA","AETNA PPO EPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA PPO EPO - CPT - 99213","AETNA","AETNA PPO EPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA PPO EPO - CPT - 99214","AETNA","AETNA PPO EPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA PPO EPO - CPT - 99214","AETNA","AETNA PPO EPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA PPO EPO - CPT - 99215","AETNA","AETNA PPO EPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA PPO EPO - CPT - 99215","AETNA","AETNA PPO EPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA PPO EPO - CPT - 99385","AETNA","AETNA PPO EPO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5,1]
["AETNA - AETNA PPO EPO - CPT - 99386","AETNA","AETNA PPO EPO","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160,1]
["AETNA - AETNA PPO EPO - CPT - A9500","AETNA","AETNA PPO EPO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["AETNA - AETNA PPO EPO - CPT - A9513","AETNA","AETNA PPO EPO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25,1]
["AETNA - AETNA PPO EPO - CPT - A9517","AETNA","AETNA PPO EPO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75,1]
["AETNA - AETNA PPO EPO - CPT - A9552","AETNA","AETNA PPO EPO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["AETNA - AETNA PPO EPO - CPT - A9555","AETNA","AETNA PPO EPO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["AETNA - AETNA PPO EPO - CPT - A9575","AETNA","AETNA PPO EPO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["AETNA - AETNA PPO EPO - CPT - A9579","AETNA","AETNA PPO EPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["AETNA - AETNA PPO EPO - CPT - A9579","AETNA","AETNA PPO EPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["AETNA - AETNA PPO EPO - CPT - A9581","AETNA","AETNA PPO EPO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["AETNA - AETNA PPO EPO - CPT - J1030","AETNA","AETNA PPO EPO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25,1]
["AETNA - AETNA PPO EPO - CPT - J3301","AETNA","AETNA PPO EPO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5,1]
["AETNA - AETNA PPO EPO - CPT - P9047","AETNA","AETNA PPO EPO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45,1]
["AETNA - AETNA PPO EPO - CPT - Q9958","AETNA","AETNA PPO EPO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9963","AETNA","AETNA PPO EPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9963","AETNA","AETNA PPO EPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9966","AETNA","AETNA PPO EPO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 19120","AETNA","AETNA STUDENT HEALTH","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 29881","AETNA","AETNA STUDENT HEALTH","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 43235","AETNA","AETNA STUDENT HEALTH","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 43239","AETNA","AETNA STUDENT HEALTH","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 45380","AETNA","AETNA STUDENT HEALTH","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 45385","AETNA","AETNA STUDENT HEALTH","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 45391","AETNA","AETNA STUDENT HEALTH","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 55700","AETNA","AETNA STUDENT HEALTH","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 55700","AETNA","AETNA STUDENT HEALTH","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 62322","AETNA","AETNA STUDENT HEALTH","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 62322","AETNA","AETNA STUDENT HEALTH","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 62323","AETNA","AETNA STUDENT HEALTH","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 64483","AETNA","AETNA STUDENT HEALTH","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 66821","AETNA","AETNA STUDENT HEALTH","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 66984","AETNA","AETNA STUDENT HEALTH","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 70450","AETNA","AETNA STUDENT HEALTH","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 70553","AETNA","AETNA STUDENT HEALTH","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 70553","AETNA","AETNA STUDENT HEALTH","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 72110","AETNA","AETNA STUDENT HEALTH","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 72148","AETNA","AETNA STUDENT HEALTH","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 72193","AETNA","AETNA STUDENT HEALTH","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 73721","AETNA","AETNA STUDENT HEALTH","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 74177","AETNA","AETNA STUDENT HEALTH","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 76700","AETNA","AETNA STUDENT HEALTH","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 76700","AETNA","AETNA STUDENT HEALTH","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 76805","AETNA","AETNA STUDENT HEALTH","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 76805","AETNA","AETNA STUDENT HEALTH","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 76830","AETNA","AETNA STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 76830","AETNA","AETNA STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 77065","AETNA","AETNA STUDENT HEALTH","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 77066","AETNA","AETNA STUDENT HEALTH","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 77067","AETNA","AETNA STUDENT HEALTH","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 80048","AETNA","AETNA STUDENT HEALTH","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 80053","AETNA","AETNA STUDENT HEALTH","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 80055","AETNA","AETNA STUDENT HEALTH","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 80061","AETNA","AETNA STUDENT HEALTH","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 80069","AETNA","AETNA STUDENT HEALTH","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 80076","AETNA","AETNA STUDENT HEALTH","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 81000","AETNA","AETNA STUDENT HEALTH","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 81000","AETNA","AETNA STUDENT HEALTH","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 81001","AETNA","AETNA STUDENT HEALTH","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 81002","AETNA","AETNA STUDENT HEALTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 81002","AETNA","AETNA STUDENT HEALTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 81003","AETNA","AETNA STUDENT HEALTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 81003","AETNA","AETNA STUDENT HEALTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 84153","AETNA","AETNA STUDENT HEALTH","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 84443","AETNA","AETNA STUDENT HEALTH","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 85025","AETNA","AETNA STUDENT HEALTH","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 85027","AETNA","AETNA STUDENT HEALTH","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 85610","AETNA","AETNA STUDENT HEALTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 85610","AETNA","AETNA STUDENT HEALTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 85730","AETNA","AETNA STUDENT HEALTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 85730","AETNA","AETNA STUDENT HEALTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90662","AETNA","AETNA STUDENT HEALTH","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90686","AETNA","AETNA STUDENT HEALTH","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90715","AETNA","AETNA STUDENT HEALTH","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90832","AETNA","AETNA STUDENT HEALTH","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90834","AETNA","AETNA STUDENT HEALTH","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90837","AETNA","AETNA STUDENT HEALTH","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90846","AETNA","AETNA STUDENT HEALTH","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90847","AETNA","AETNA STUDENT HEALTH","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 90853","AETNA","AETNA STUDENT HEALTH","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 93452","AETNA","AETNA STUDENT HEALTH","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 95810","AETNA","AETNA STUDENT HEALTH","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 97110","AETNA","AETNA STUDENT HEALTH","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99203","AETNA","AETNA STUDENT HEALTH","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99203","AETNA","AETNA STUDENT HEALTH","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99204","AETNA","AETNA STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99204","AETNA","AETNA STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99205","AETNA","AETNA STUDENT HEALTH","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99205","AETNA","AETNA STUDENT HEALTH","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99212","AETNA","AETNA STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99212","AETNA","AETNA STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99213","AETNA","AETNA STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99213","AETNA","AETNA STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99214","AETNA","AETNA STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99214","AETNA","AETNA STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99215","AETNA","AETNA STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99215","AETNA","AETNA STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99385","AETNA","AETNA STUDENT HEALTH","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - 99386","AETNA","AETNA STUDENT HEALTH","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9500","AETNA","AETNA STUDENT HEALTH","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,188.85,128.52000000000001,456.36,89.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9513","AETNA","AETNA STUDENT HEALTH","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,226.94,154.44,456.36,107.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9517","AETNA","AETNA STUDENT HEALTH","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9552","AETNA","AETNA STUDENT HEALTH","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,536.94000000000005,365.4,1015,253.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9555","AETNA","AETNA STUDENT HEALTH","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,732.67,420.34,1385,346.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9575","AETNA","AETNA STUDENT HEALTH","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,4.2300000000000004,0.13,456.36,2,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9579","AETNA","AETNA STUDENT HEALTH","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,1.59,1.08,456.36,0.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9579","AETNA","AETNA STUDENT HEALTH","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,2.65,1.57,456.36,1.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9581","AETNA","AETNA STUDENT HEALTH","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,52.37,15.3,456.36,24.75,1]
["AETNA - AETNA STUDENT HEALTH - CPT - J1030","AETNA","AETNA STUDENT HEALTH","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - J3301","AETNA","AETNA STUDENT HEALTH","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - P9047","AETNA","AETNA STUDENT HEALTH","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9958","AETNA","AETNA STUDENT HEALTH","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,0.53,0.09,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9963","AETNA","AETNA STUDENT HEALTH","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.53,0.22,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9963","AETNA","AETNA STUDENT HEALTH","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.53,0.22,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9966","AETNA","AETNA STUDENT HEALTH","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,0.53,0.36,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,1.06,0.12,456.36,0.5,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.53,0.12,456.36,0.25,1]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,1.06,0.12,456.36,0.5,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 19120","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 29881","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 43235","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 43239","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45380","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45385","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45391","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 55700","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 55700","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62322","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62322","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62323","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 64483","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 66821","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 66984","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70450","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70553","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70553","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72110","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72148","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72193","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 73721","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 74177","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 80048","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 90834","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - P9047","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - Q9967","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS - BCBS HMO - CPT - 72110","BCBS","BCBS HMO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,128.66,46.45,595,148.75,1]
["BCBS - BCBS HMO - CPT - 85730","BCBS","BCBS HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,12.03,5.3,456.36,10.5,1]
["BCBS - BCBS HMO - CPT - 99214","BCBS","BCBS HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,32.18,23.27,456.36,105.5,1]
["BCBS - BCBS HMO - CPT - Q9967","BCBS","BCBS HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["BCBS - BCBS INDEMNITY - CPT - 45378","BCBS","BCBS INDEMNITY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1370.57,395.43,2154,538.5,1]
["BCBS - BCBS INDEMNITY - CPT - 80061","BCBS","BCBS INDEMNITY","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,26.35,11.81,456.36,32.25,1]
["BCBS - BCBS INDEMNITY - CPT - 99204","BCBS","BCBS INDEMNITY","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,32.18,23.27,705,176.25,1]
["BCBS - BCBS INDEMNITY - CPT - A9579","BCBS","BCBS INDEMNITY","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["BCBS - BCBS INDEMNITY - CPT - Q9967","BCBS","BCBS INDEMNITY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS - BCBS POS - CPT - 76830","BCBS","BCBS POS","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,128.66,113.99,873.8,257,1]
["BCBS - BCBS POS - CPT - 85730","BCBS","BCBS POS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,12.03,5.3,456.36,10.5,1]
["BCBS - BCBS POS - CPT - A9513","BCBS","BCBS POS","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,318.61,154.44,456.36,107.25,1]
["BCBS - BCBS POS - CPT - A9579","BCBS","BCBS POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["BCBS - BCBS PPO - CPT - 62323","BCBS","BCBS PPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1101.79,420.34,1505.24,371.25,1]
["BCBS - BCBS PPO - CPT - 80076","BCBS","BCBS PPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,16.04,7.21,456.36,40.75,1]
["BCBS - BCBS PPO - CPT - 99205","BCBS","BCBS PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,32.18,23.27,899,224.75,1]
["BCBS - BCBS PPO - CPT - 99385","BCBS","BCBS PPO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,342.38,23.27,530,132.5,1]
["BCBS - BCBS PPO - CPT - Q9967","BCBS","BCBS PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS - BCBS SHIP PPO - CPT - 76830","BCBS","BCBS SHIP PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,128.66,113.99,873.8,257,1]
["BCBS - BCBS SHIP PPO - CPT - 81000","BCBS","BCBS SHIP PPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,6.3,2.89,456.36,6,1]
["BCBS - BCBS SHIP PPO - CPT - 95810","BCBS","BCBS SHIP PPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1679.52,420.34,3344.75,983.75,1]
["BCBS - BCBS SHIP PPO - CPT - Q9966","BCBS","BCBS SHIP PPO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["BCBS - BCBS STANDARD - CPT - 73721","BCBS","BCBS STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,574.25,254.07,4304.3999999999996,1266,1]
["BCBS - BCBS STANDARD - CPT - 84443","BCBS","BCBS STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,33.22,14.82,456.36,28.5,1]
["BCBS - BCBS STANDARD - CPT - 90715","BCBS","BCBS STANDARD","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["BCBS - BCBS STANDARD - CPT - 99386","BCBS","BCBS STANDARD","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,413.44,23.27,640,160,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 62323","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1101.79,420.34,1505.24,371.25,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 66984","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,3527.53,420.34,4241.13,556,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 81000","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,6.3,2.89,456.36,6,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 99212","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,32.18,23.27,456.36,36.75,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - A9581","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 74177","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 77067","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 99203","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - P9047","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - Q9967","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 70553","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 90853","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 99214","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 45378","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1370.57,395.43,2154,538.5,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 62323","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1101.79,420.34,1505.24,371.25,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 90662","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,73.400000000000006,36.119999999999997,456.36,32.25,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 99205","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,32.18,23.27,899,224.75,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 99385","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,342.38,23.27,530,132.5,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - Q9967","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 74177","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,961.1,398.75,2773.55,815.75,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 90686","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,22.35,19.16,456.36,18.5,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - A9579","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - Q9966","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 64483","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1407.29,420.34,1879.97,386.25,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 84443","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,33.22,14.82,456.36,28.5,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 99212","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,32.18,23.27,456.36,36.75,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - Q9967","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 45385","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1802.8,420.34,2929.62,760,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 77066","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,214.37,131.5,924,231,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 95810","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1679.52,420.34,3344.75,983.75,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 99205","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,32.18,23.27,899,224.75,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - Q9967","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["CCA - CCA SCO ONECARE - CPT - 74177","CCA","CCA SCO ONECARE","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,453.39,398.75,2773.55,815.75,1]
["CCA - CCA SCO ONECARE - CPT - 85025","CCA","CCA SCO ONECARE","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,8.16,6.85,456.36,13.75,1]
["CCA - CCA SCO ONECARE - CPT - 93452","CCA","CCA SCO ONECARE","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["CCA - CCA SCO ONECARE - CPT - Q9963","CCA","CCA SCO ONECARE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["CCA - CCA SCO STANDARD - CPT - 62322","CCA","CCA SCO STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["CCA - CCA SCO STANDARD - CPT - 81003","CCA","CCA SCO STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25,1]
["CCA - CCA SCO STANDARD - CPT - 90847","CCA","CCA SCO STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,187.97,30.9,456.36,90.75,1]
["CCA - CCA SCO STANDARD - CPT - A9513","CCA","CCA SCO STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,304.95999999999998,154.44,456.36,107.25,1]
["CCA - ZZZCCA STANDARD - CPT - 45391","CCA","ZZZCCA STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1391.24,420.34,2924,731,1]
["CCA - ZZZCCA STANDARD - CPT - 81000","CCA","ZZZCCA STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6,1]
["CCA - ZZZCCA STANDARD - CPT - 81002","CCA","ZZZCCA STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25,1]
["CCA - ZZZCCA STANDARD - CPT - 99214","CCA","ZZZCCA STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,155.85,23.27,456.36,105.5,1]
["CCA - ZZZCCA STANDARD - CPT - Q9967","CCA","ZZZCCA STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 62323","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,815.3,420.34,1505.24,371.25,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 90715","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 97110","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,33.72,23.1,456.36,62.25,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - Q9967","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 45385","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1391.24,420.34,2929.62,760,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 76805","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,129.61000000000001,113.99,1013.2,298,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 90847","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,187.97,30.9,456.36,90.75,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - A9579","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 45378","CCA MEDICARE PREFERRED","ZZZCCA","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5,1]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 80076","CCA MEDICARE PREFERRED","ZZZCCA","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.58,7.21,456.36,40.75,1]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 84443","CCA MEDICARE PREFERRED","ZZZCCA","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,17.64,14.82,456.36,28.5,1]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - A9517","CCA MEDICARE PREFERRED","ZZZCCA","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.41,20.12,456.36,130.75,1]
["CIGNA - CIGNA CARELINK - CPT - 19120","CIGNA","CIGNA CARELINK","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,5615.19,420.34,6229.57,1049.75,1]
["CIGNA - CIGNA CARELINK - CPT - 62322","CIGNA","CIGNA CARELINK","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5,1]
["CIGNA - CIGNA CARELINK - CPT - 81002","CIGNA","CIGNA CARELINK","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,9.51,2.34,456.36,4.25,1]
["CIGNA - CIGNA CARELINK - CPT - 90853","CIGNA","CIGNA CARELINK","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,18.329999999999998,15.63,456.36,32.25,1]
["CIGNA - CIGNA CARELINK - CPT - Q9967","CIGNA","CIGNA CARELINK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CIGNA - CIGNA LOCALPLUS - CPT - 70553","CIGNA","CIGNA LOCALPLUS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,5879.45,398.75,5879.45,1729.25,1]
["CIGNA - CIGNA LOCALPLUS - CPT - 76805","CIGNA","CIGNA LOCALPLUS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,1013.2,113.99,1013.2,298,1]
["CIGNA - CIGNA LOCALPLUS - CPT - 90715","CIGNA","CIGNA LOCALPLUS","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,153,39.75,456.36,45,1]
["CIGNA - CIGNA LOCALPLUS - CPT - A9555","CIGNA","CIGNA LOCALPLUS","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1177.25,420.34,1385,346.25,1]
["CIGNA - CIGNA LOCALPLUS - CPT - Q9963","CIGNA","CIGNA LOCALPLUS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.85,0.22,456.36,0.25,1]
["CIGNA - CIGNA STANDARD - CPT - 62322","CIGNA","CIGNA STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1212.0999999999999,82.95,1426,356.5,1]
["CIGNA - CIGNA STANDARD - CPT - 84153","CIGNA","CIGNA STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,20.34,13.26,456.36,31.25,1]
["CIGNA - CIGNA STANDARD - CPT - 99215","CIGNA","CIGNA STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,505.75,23.27,595,148.75,1]
["CIGNA - CIGNA STANDARD - CPT - Q9967","CIGNA","CIGNA STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.85,0.12,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 45378","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 81000","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 95810","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1232.6400000000001,420.34,3344.75,983.75,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 99212","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,155.85,23.27,456.36,36.75,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - Q9967","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 80053","CORRECTIONS","CORRECTIONS BRISTOL","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,11.09,9.31,456.36,67.75,1]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 90846","CORRECTIONS","CORRECTIONS BRISTOL","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,187.97,30.9,456.36,77,1]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - A9575","CORRECTIONS","CORRECTIONS BRISTOL","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - Q9967","CORRECTIONS","CORRECTIONS BRISTOL","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 64483","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1074.5899999999999,420.34,1879.97,386.25,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 84153","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 90832","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,187.97,21.97,456.36,42,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - Q9963","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 55700","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 81002","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 99204","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,155.85,23.27,705,176.25,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - Q9958","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - Q9967","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 77065","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 81000","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - A9579","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - Q9967","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 76805","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,129.61000000000001,113.99,1013.2,298,1]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 81002","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25,1]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 93452","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9581","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 66821","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,685.29,420.34,2389.35,702.75,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 81001","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.33,2.8,456.36,6,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 85027","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.79,5.71,456.36,11.25,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - A9555","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 45378","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1128.82,395.43,2154,538.5,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 80055","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,52.59,18.32,456.36,65,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 81003","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.48,1.63,456.36,4.25,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 99212","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,37.01,23.27,456.36,36.75,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 19120","CORRECTIONS","CORRECTIONS ICE INMATE","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4493.84,420.34,6229.57,1049.75,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 55700","CORRECTIONS","CORRECTIONS ICE INMATE","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 80048","CORRECTIONS","CORRECTIONS ICE INMATE","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.8800000000000008,7.46,456.36,41.75,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 99204","CORRECTIONS","CORRECTIONS ICE INMATE","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,155.85,23.27,705,176.25,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - Q9963","CORRECTIONS","CORRECTIONS ICE INMATE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 45378","CORRECTIONS","CORRECTIONS MIDDLESEX","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 76830","CORRECTIONS","CORRECTIONS MIDDLESEX","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 90715","CORRECTIONS","CORRECTIONS MIDDLESEX","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - Q9963","CORRECTIONS","CORRECTIONS MIDDLESEX","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 55700","CORRECTIONS","CORRECTIONS NAPHCARE","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 70553","CORRECTIONS","CORRECTIONS NAPHCARE","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,453.39,398.75,5879.45,1729.25,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 85610","CORRECTIONS","CORRECTIONS NAPHCARE","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.5,3.58,456.36,7.25,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - A9579","CORRECTIONS","CORRECTIONS NAPHCARE","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 45378","CORRECTIONS","CORRECTIONS NASHUA","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5,1]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 64483","CORRECTIONS","CORRECTIONS NASHUA","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1074.5899999999999,420.34,1879.97,386.25,1]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 80076","CORRECTIONS","CORRECTIONS NASHUA","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.58,7.21,456.36,40.75,1]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 90846","CORRECTIONS","CORRECTIONS NASHUA","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,187.97,30.9,456.36,77,1]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - Q9967","CORRECTIONS","CORRECTIONS NASHUA","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 43239","CORRECTIONS","CORRECTIONS NORFOLK","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1068.7,420.34,1871.88,428,1]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 80053","CORRECTIONS","CORRECTIONS NORFOLK","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,11.09,9.31,456.36,67.75,1]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 85730","CORRECTIONS","CORRECTIONS NORFOLK","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5,1]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - Q9966","CORRECTIONS","CORRECTIONS NORFOLK","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - Q9967","CORRECTIONS","CORRECTIONS NORFOLK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 62322","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 76700","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,129.61000000000001,111.92,961.35,282.75,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81000","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81003","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 90834","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,187.97,27.84,456.36,53.75,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99213","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,155.85,23.27,456.36,69.25,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - Q9958","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - Q9967","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 45378","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 81000","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 99203","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,155.85,23.27,456.36,103.75,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 99214","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,102.14,23.27,456.36,105.5,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 29881","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 64483","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1074.5899999999999,420.34,1879.97,386.25,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 76830","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 81002","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 85027","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.79,5.71,456.36,11.25,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 97110","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,33.72,23.1,456.36,62.25,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99215","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,151.75,23.27,595,148.75,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - A9517","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.41,20.12,456.36,130.75,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - Q9967","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 62323","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,854.12,420.34,1505.24,371.25,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 81003","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.48,1.63,456.36,4.25,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 85730","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.61,5.3,456.36,10.5,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - A9517","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,23.47,20.12,456.36,130.75,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 55700","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 80048","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.8800000000000008,7.46,456.36,41.75,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 85610","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.5,3.58,456.36,7.25,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 99205","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,190.61,23.27,899,224.75,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 76830","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 81003","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 99203","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,155.85,23.27,456.36,103.75,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 70553","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,453.39,398.75,5879.45,1729.25,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 81002","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 85730","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - A9579","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 45378","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 81000","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 85025","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,8.16,6.85,456.36,13.75,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 99213","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,155.85,23.27,456.36,69.25,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 62322","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 80061","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,14.06,11.81,456.36,32.25,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 99205","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,190.61,23.27,899,224.75,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 74177","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,453.39,398.75,2773.55,815.75,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 77067","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 90837","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,187.97,27.84,456.36,53.75,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - Q9966","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 72148","CORRECTIONS","ZZZCORRECTIONS CONCORD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,288.89,254.07,3938.05,1158.25,1]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 85730","CORRECTIONS","ZZZCORRECTIONS CONCORD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5,1]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 99204","CORRECTIONS","ZZZCORRECTIONS CONCORD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,155.85,23.27,705,176.25,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 45391","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1391.24,420.34,2924,731,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 70450","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,129.61000000000001,113.99,1718.7,505.5,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 84153","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 99214","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,102.14,23.27,456.36,105.5,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9579","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 45378","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 81003","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 97110","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,33.72,23.1,456.36,62.25,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 43235","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1068.7,420.34,1871.88,376.25,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 80076","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.58,7.21,456.36,40.75,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90847","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,187.97,30.9,456.36,90.75,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 99205","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,190.61,23.27,899,224.75,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - Q9966","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 62322","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 84443","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,17.64,14.82,456.36,28.5,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9517","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.41,20.12,456.36,130.75,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - P9047","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,55.73,50.13,456.36,45,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 45380","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1391.24,420.34,2575,643.75,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 81002","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 85730","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 45385","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1391.24,420.34,2929.62,760,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 77066","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 99203","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,85.93,23.27,456.36,103.75,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 99204","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,140.03,23.27,705,176.25,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 76805","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,129.61000000000001,113.99,1013.2,298,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 85730","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 93452","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 66984","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2747.38,420.34,4241.13,556,1]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 85025","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,8.16,6.85,456.36,13.75,1]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 90847","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,187.97,30.9,456.36,90.75,1]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - A9575","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 62322","CORRECTIONS","ZZZCORRECTIONS NASHUA","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 81000","CORRECTIONS","ZZZCORRECTIONS NASHUA","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 84153","CORRECTIONS","ZZZCORRECTIONS NASHUA","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - A9513","CORRECTIONS","ZZZCORRECTIONS NASHUA","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,304.95999999999998,154.44,456.36,107.25,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 29881","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 62323","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,815.3,420.34,1505.24,371.25,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 90846","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,187.97,30.9,456.36,77,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 99204","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,155.85,23.27,705,176.25,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 45385","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1391.24,420.34,2929.62,760,1]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 77065","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188,1]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 97110","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,33.72,23.1,456.36,62.25,1]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - J3301","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 45378","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 81002","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 85610","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.5,3.58,456.36,7.25,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - A9579","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 19120","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4493.84,420.34,6229.57,1049.75,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 66821","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,685.29,420.34,2389.35,702.75,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 84443","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,17.64,14.82,456.36,28.5,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 95810","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1232.6400000000001,420.34,3344.75,983.75,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 43239","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1068.7,420.34,1871.88,428,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 76805","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,129.61000000000001,113.99,1013.2,298,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 80055","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,50.2,18.32,456.36,65,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 90853","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,105.09,15.63,456.36,32.25,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 19120","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4493.84,420.34,6229.57,1049.75,1]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 74177","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,453.39,398.75,2773.55,815.75,1]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 90715","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9958","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 62322","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 72110","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,129.61000000000001,46.45,595,148.75,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 85730","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - A9500","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - J1030","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 45391","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1391.24,420.34,2924,731,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 84153","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 99214","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,102.14,23.27,456.36,105.5,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - Q9967","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 45380","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1391.24,420.34,2575,643.75,1]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 76830","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257,1]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 95810","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1232.6400000000001,420.34,3344.75,983.75,1]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 99212","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,37.01,23.27,456.36,36.75,1]
["FALLON - FALLON COMMUNITY PLAN - CPT - 29881","FALLON","FALLON COMMUNITY PLAN","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2727,420.34,5454,1363.5,1]
["FALLON - FALLON COMMUNITY PLAN - CPT - 76700","FALLON","FALLON COMMUNITY PLAN","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,565.5,111.92,961.35,282.75,1]
["FALLON - FALLON COMMUNITY PLAN - CPT - 90834","FALLON","FALLON COMMUNITY PLAN","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,107.5,27.84,456.36,53.75,1]
["FALLON - FALLON COMMUNITY PLAN - CPT - A9513","FALLON","FALLON COMMUNITY PLAN","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,214.5,154.44,456.36,107.25,1]
["FALLON - FALLON COMMUNITY PLAN - CPT - Q9967","FALLON","FALLON COMMUNITY PLAN","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.5,0.12,456.36,0.25,1]
["FALLON - FALLON HMO STANDARD - CPT - 55700","FALLON","FALLON HMO STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1174,420.34,3848.68,587,1]
["FALLON - FALLON HMO STANDARD - CPT - 81002","FALLON","FALLON HMO STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.5,2.34,456.36,4.25,1]
["FALLON - FALLON HMO STANDARD - CPT - 85610","FALLON","FALLON HMO STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,14.5,3.58,456.36,7.25,1]
["FALLON - FALLON HMO STANDARD - CPT - J3301","FALLON","FALLON HMO STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9,0.98,456.36,4.5,1]
["FALLON - FALLON POS STANDARD - CPT - 43239","FALLON","FALLON POS STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,856,420.34,1871.88,428,1]
["FALLON - FALLON POS STANDARD - CPT - 80053","FALLON","FALLON POS STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,135.5,9.31,456.36,67.75,1]
["FALLON - FALLON POS STANDARD - CPT - 90837","FALLON","FALLON POS STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,107.5,27.84,456.36,53.75,1]
["FALLON - FALLON POS STANDARD - CPT - 90847","FALLON","FALLON POS STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,181.5,30.9,456.36,90.75,1]
["FALLON - FALLON POS STANDARD - CPT - Q9958","FALLON","FALLON POS STANDARD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,0.5,0.09,456.36,0.25,1]
["FALLON - FALLON PPO STANDARD - CPT - 70553","FALLON","FALLON PPO STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3458.5,398.75,5879.45,1729.25,1]
["FALLON - FALLON PPO STANDARD - CPT - 81001","FALLON","FALLON PPO STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12,2.8,456.36,6,1]
["FALLON - FALLON PPO STANDARD - CPT - 85730","FALLON","FALLON PPO STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,21,5.3,456.36,10.5,1]
["FALLON - FALLON PPO STANDARD - CPT - A9555","FALLON","FALLON PPO STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,692.5,420.34,1385,346.25,1]
["FALLON HEALTHCRE ACO - FALLON HEALTHCARE ACO ATRIUS - CPT - 80069","FALLON HEALTHCRE ACO","FALLON HEALTHCARE ACO ATRIUS","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75,1]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO BRKSHRE - CPT - 81003","FALLON HEALTHCRE ACO","FALLON HEALTHCRE ACO BRKSHRE","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25,1]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO RELIANT - CPT - 80076","FALLON HEALTHCRE ACO","FALLON HEALTHCRE ACO RELIANT","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 CARE PLUS - CPT - 81002","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 CARE PLUS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST - CPT - 80048","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST - CPT - 81000","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 STANDARD - CPT - 84443","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - CPT - 80076","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST - CPT - 81002","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD - CPT - 80048","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WELLFORCE - CPT - 81002","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WELLFORCE","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE CAREPLUS - CPT - 84443","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE CAREPLUS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 80076","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 85025","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75,1]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE STANDARD - CPT - 85730","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["FALLON MEDICAID MANAGED - FALLON MCD MNG STANDARD - CPT - 81002","FALLON MEDICAID MANAGED","FALLON MCD MNG STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 70553","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 84153","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 90686","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - A9500","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - Q9967","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 77067","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 81001","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 99213","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - A9581","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 76805","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 80055","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65,1]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 90846","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77,1]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - A9555","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["FALLON SCO - FALLON SCO HMO - CPT - 62323","FALLON SCO","FALLON SCO HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25,1]
["FALLON SCO - FALLON SCO HMO - CPT - 72193","FALLON SCO","FALLON SCO HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760,1]
["FALLON SCO - FALLON SCO HMO - CPT - 81001","FALLON SCO","FALLON SCO HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6,1]
["FALLON SCO - FALLON SCO HMO - CPT - A9500","FALLON SCO","FALLON SCO HMO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 45385","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 45391","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,2408.3200000000002,420.34,2924,731,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 80048","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,25.66,7.46,456.36,41.75,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 99213","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - Q9967","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 29881","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,5454,420.34,5454,1363.5,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 76805","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 90834","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,108.15,27.84,456.36,53.75,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - J1030","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - J3301","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 70553","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,755.93,398.75,5879.45,1729.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 85610","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 99213","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - A9517","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,36.409999999999997,20.12,456.36,130.75,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 62322","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 80053","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,32.049999999999997,9.31,456.36,67.75,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 99203","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,415,23.27,456.36,103.75,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 99205","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - Q9967","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 76805","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 85610","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 97110","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,145.28,23.1,456.36,62.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - A9555","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 62322","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 81002","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.5500000000000007,2.34,456.36,4.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 90686","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,22.35,19.16,456.36,18.5,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 99215","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 45378","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 76805","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 85027","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,17.649999999999999,5.71,456.36,11.25,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 90853","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,64.89,15.63,456.36,32.25,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - Q9963","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 45378","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 72193","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,395.2,190.5,2584,760,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 90662","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,73.400000000000006,36.119999999999997,456.36,32.25,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 99215","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - Q9967","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 64483","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1879.97,420.34,1879.97,386.25,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 80076","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,22.32,7.21,456.36,40.75,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 99205","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - Q9966","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - Q9967","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 77065","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,752,102.59,752,188,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 90686","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,22.35,19.16,456.36,18.5,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - A9575","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - Q9967","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["HLTH NEW ENGLAND ACO - HLTH NEW ENGLAND ACO BE HEALTHY - CPT - 85027","HLTH NEW ENGLAND ACO","HLTH NEW ENGLAND ACO BE HEALTHY","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,5.71,5.71,456.36,11.25,1]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 76805","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 90846","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77,1]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 90847","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75,1]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - Q9963","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["HSN - HSN STANDARD - CPT - 64483","HSN","HSN STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,456.36,420.34,1879.97,386.25,1]
["HSN - HSN STANDARD - CPT - 84153","HSN","HSN STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,456.36,13.26,456.36,31.25,1]
["HSN - HSN STANDARD - CPT - 90686","HSN","HSN STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,456.36,19.16,456.36,18.5,1]
["HSN - HSN STANDARD - CPT - 99385","HSN","HSN STANDARD","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,456.36,23.27,530,132.5,1]
["HSN - HSN TEMPORARY - CPT - 45391","HSN","HSN TEMPORARY","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,456.36,420.34,2924,731,1]
["HSN - HSN TEMPORARY - CPT - 77065","HSN","HSN TEMPORARY","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,456.36,102.59,752,188,1]
["HSN - HSN TEMPORARY - CPT - 81000","HSN","HSN TEMPORARY","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,456.36,2.89,456.36,6,1]
["HSN - HSN TEMPORARY - CPT - 99212","HSN","HSN TEMPORARY","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,456.36,23.27,456.36,36.75,1]
["HSN - HSN TEMPORARY - CPT - Q9967","HSN","HSN TEMPORARY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,456.36,0.12,456.36,0.25,1]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 73721","HSN BAD DEBT","HSN BAD DEBT","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,456.36,254.07,4304.3999999999996,1266,1]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 77066","HSN BAD DEBT","HSN BAD DEBT","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,456.36,131.5,924,231,1]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 90715","HSN BAD DEBT","HSN BAD DEBT","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,456.36,39.75,456.36,45,1]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 99213","HSN BAD DEBT","HSN BAD DEBT","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,456.36,23.27,456.36,69.25,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 45385","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,456.36,420.34,2929.62,760,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 66984","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,456.36,420.34,4241.13,556,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 85025","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,456.36,6.85,456.36,13.75,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 97110","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,456.36,23.1,456.36,62.25,1]
["HSN DENTAL - HSN DENTAL - CPT - 19120","HSN DENTAL","HSN DENTAL","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,456.36,420.34,6229.57,1049.75,1]
["HSN DENTAL - HSN DENTAL - CPT - 45391","HSN DENTAL","HSN DENTAL","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,456.36,420.34,2924,731,1]
["HSN DENTAL - HSN DENTAL - CPT - 81003","HSN DENTAL","HSN DENTAL","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,456.36,1.63,456.36,4.25,1]
["HSN DENTAL - HSN DENTAL - CPT - 99203","HSN DENTAL","HSN DENTAL","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,456.36,23.27,456.36,103.75,1]
["HSN DENTAL - HSN DENTAL - CPT - J1030","HSN DENTAL","HSN DENTAL","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,456.36,4.68,456.36,3.25,1]
["HSN DENTAL - HSN DENTAL - CPT - Q9967","HSN DENTAL","HSN DENTAL","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,456.36,0.12,456.36,0.25,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 81000","HSN PARTIAL","HSN PARTIAL STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,456.36,2.89,456.36,6,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 85610","HSN PARTIAL","HSN PARTIAL STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,456.36,3.58,456.36,7.25,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - A9513","HSN PARTIAL","HSN PARTIAL STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,456.36,154.44,456.36,107.25,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 29881","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,456.36,420.34,5454,1363.5,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 45378","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,456.36,395.43,2154,538.5,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 81002","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,456.36,2.34,456.36,4.25,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 99203","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,456.36,23.27,456.36,103.75,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 99214","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,456.36,23.27,456.36,105.5,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 19120","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 76805","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 90837","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - A9555","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - Q9967","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO - MASS GENERAL BRIG HLTH PLAN ACO STANDARD - CPT - 80053","MASS GENERAL BRIGHAM HEALTH PLAN ACO","MASS GENERAL BRIG HLTH PLAN ACO STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 45378","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1213.1300000000001,395.43,2154,538.5,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 62323","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,836.35,420.34,1505.24,371.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 80076","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,91.8,7.21,456.36,40.75,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 99205","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - Q9967","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,1.1299999999999999,0.12,456.36,0.5,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 45378","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1213.1300000000001,395.43,2154,538.5,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 77065","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,423.53,102.59,752,188,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 93452","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3580.83,420.34,6358,1589.5,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - A9579","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,1.69,1.08,456.36,0.75,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - Q9967","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.56000000000000005,0.12,456.36,0.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 66821","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1583.16,420.34,2389.35,702.75,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 84443","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,64.2,14.82,456.36,28.5,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 99385","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,298.5,23.27,530,132.5,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - Q9963","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.56000000000000005,0.22,456.36,0.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - CPT - 81001","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG COMMON","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6,1]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST - CPT - 85730","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGH HLTHPLAN MCD MNG CMA - CPT - 81002","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGH HLTHPLAN MCD MNG CMA","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC - CPT - 84153","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.22,13.26,456.36,31.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG CARE - CPT - 85610","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG CARE","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE HMO - CPT - 81001","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.22,2.8,456.36,6,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1 - CPT - 81001","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.22,2.8,456.36,6,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - CPT - 80069","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.81,7.66,456.36,48.75,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - CPT - 84153","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.649999999999999,13.26,456.36,31.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 66984","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1252.56,420.34,4241.13,556,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 81002","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,9.57,2.34,456.36,4.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 90834","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,121.09,27.84,456.36,53.75,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - A9513","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,241.61,154.44,456.36,107.25,1]
["MEDICAID - CMSP STANDARD - CPT - 81002","MEDICAID","CMSP STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["MEDICAID - MEDICAID CARE PLUS - CPT - 85610","MEDICAID","MEDICAID CARE PLUS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["MEDICAID - MEDICAID CORRECTIONS IP - CPT - 80076","MEDICAID","MEDICAID CORRECTIONS IP","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75,1]
["MEDICAID - MEDICAID CORRECTIONS IP - CPT - 84443","MEDICAID","MEDICAID CORRECTIONS IP","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5,1]
["MEDICAID - MEDICAID EAEDC - CPT - 85610","MEDICAID","MEDICAID EAEDC","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["MEDICAID - MEDICAID SENIOR BUY-IN - CPT - 81003","MEDICAID","MEDICAID SENIOR BUY-IN","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25,1]
["MEDICAID - MEDICAID SENIOR BUY-IN - CPT - 85730","MEDICAID","MEDICAID SENIOR BUY-IN","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["MEDICAID ACO - MEDICAID ACO COMM - CPT - 80055","MEDICAID ACO","MEDICAID ACO COMM","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65,1]
["MEDICAID ACO - MEDICAID ACO MASS GENERAL BRIG - CPT - 81003","MEDICAID ACO","MEDICAID ACO MASS GENERAL BRIG","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25,1]
["MEDICAID ACO - MEDICAID ACO STEWRD FAM ASSIS - CPT - 81000","MEDICAID ACO","MEDICAID ACO STEWRD FAM ASSIS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6,1]
["MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - CPT - 81002","MEDICAID ACO","ZZZMEDICAID ACO COMM CARE PLUS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - CPT - 85730","MEDICAID ACO","ZZZMEDICAID ACO COMM CARE PLUS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["MEDICAID ACO - ZZZMEDICAID ACO COMM FAM ASSIST - CPT - 81000","MEDICAID ACO","ZZZMEDICAID ACO COMM FAM ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6,1]
["MEDICAID ACO - ZZZMEDICAID ACO COMM STANDARD - CPT - 85025","MEDICAID ACO","ZZZMEDICAID ACO COMM STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75,1]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS - CPT - 80061","MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25,1]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG COMMONHLT - CPT - 81000","MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG COMMONHLT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6,1]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - CPT - 80069","MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75,1]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD CARE PLUS - CPT - 80061","MEDICAID ACO","ZZZMEDICAID ACO STEWRD CARE PLUS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25,1]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD COMMONHLT - CPT - 85025","MEDICAID ACO","ZZZMEDICAID ACO STEWRD COMMONHLT","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75,1]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD FAM ASSIS - CPT - 80061","MEDICAID ACO","ZZZMEDICAID ACO STEWRD FAM ASSIS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25,1]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD STANDARD - CPT - 85730","MEDICAID ACO","ZZZMEDICAID ACO STEWRD STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["MEDICAID LIMITED - MEDICAID LIMITED LIMITED - CPT - 85730","MEDICAID LIMITED","MEDICAID LIMITED LIMITED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["MEDICAID MANAGED CARE - MCD MNG CARE CARE PLUS - CPT - 81001","MEDICAID MANAGED CARE","MCD MNG CARE CARE PLUS","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6,1]
["MEDICAID MANAGED CARE - MCD MNG CARE COMMONHEALTH - CPT - 81003","MEDICAID MANAGED CARE","MCD MNG CARE COMMONHEALTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25,1]
["MEDICAID MANAGED CARE - MCD MNG CARE FAMILY ASSIST - CPT - 85610","MEDICAID MANAGED CARE","MCD MNG CARE FAMILY ASSIST","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["MEDICAID MANAGED CARE - MCD MNG CARE STANDARD - CPT - 81001","MEDICAID MANAGED CARE","MCD MNG CARE STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6,1]
["MEDICARE - MEDICARE A&B - CPT - 70553","MEDICARE","MEDICARE A&B","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["MEDICARE - MEDICARE A&B - CPT - 80069","MEDICARE","MEDICARE A&B","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75,1]
["MEDICARE - MEDICARE A&B - CPT - 85730","MEDICARE","MEDICARE A&B","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["MEDICARE - MEDICARE A&B - CPT - A9579","MEDICARE","MEDICARE A&B","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["MEDICARE - MEDICARE PART A ONLY - CPT - 45378","MEDICARE","MEDICARE PART A ONLY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["MEDICARE - MEDICARE PART A ONLY - CPT - 76830","MEDICARE","MEDICARE PART A ONLY","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["MEDICARE - MEDICARE PART A ONLY - CPT - 84443","MEDICARE","MEDICARE PART A ONLY","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5,1]
["MEDICARE - MEDICARE PART A ONLY - CPT - 99212","MEDICARE","MEDICARE PART A ONLY","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["MEDICARE - MEDICARE PART B ONLY - CPT - 19120","MEDICARE","MEDICARE PART B ONLY","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["MEDICARE - MEDICARE PART B ONLY - CPT - 76700","MEDICARE","MEDICARE PART B ONLY","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["MEDICARE - MEDICARE PART B ONLY - CPT - 80048","MEDICARE","MEDICARE PART B ONLY","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75,1]
["MEDICARE - MEDICARE PART B ONLY - CPT - 99203","MEDICARE","MEDICARE PART B ONLY","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["MEDICARE - MEDICARE PART B ONLY - CPT - P9047","MEDICARE","MEDICARE PART B ONLY","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45,1]
["MEDICARE - MEDICARE PART B ONLY - CPT - Q9967","MEDICARE","MEDICARE PART B ONLY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 76805","MEDICARE","RAILROAD MEDICARE  RAILROAD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 85730","MEDICARE","RAILROAD MEDICARE  RAILROAD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - A9513","MEDICARE","RAILROAD MEDICARE  RAILROAD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - Q9966","MEDICARE","RAILROAD MEDICARE  RAILROAD","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 64483","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 84153","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 99212","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - A9513","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 45391","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,2924,420.34,2924,731,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 77067","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,162.43,108.47,488,122,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 99204","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,328.17,23.27,705,176.25,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - P9047","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,138.30000000000001,50.13,456.36,45,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - Q9967","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 76805","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,272.94,113.99,1013.2,298,1]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 80061","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,12.05,11.81,456.36,32.25,1]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 90847","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,363,30.9,456.36,90.75,1]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - Q9963","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 62323","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,931.77,420.34,1505.24,371.25,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 77067","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 99212","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,178.11,23.27,456.36,36.75,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - A9517","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,25.61,20.12,456.36,130.75,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 70553","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,518.16,398.75,5879.45,1729.25,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 80055","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,57.37,18.32,456.36,65,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 81003","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.7,1.63,456.36,4.25,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 99205","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,178.11,23.27,899,224.75,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - Q9963","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 77067","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,112.53,108.47,488,122,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 90837","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,150.5,27.84,456.36,53.75,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 99204","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,137.06,23.27,705,176.25,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - J3301","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 70553","TRICARE EAST","TRICARE EAST SELECT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,398.75,398.75,5879.45,1729.25,1]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 76805","TRICARE EAST","TRICARE EAST SELECT","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,113.99,113.99,1013.2,298,1]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 85730","TRICARE EAST","TRICARE EAST SELECT","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,7.24,5.3,456.36,10.5,1]
["TRICARE EAST - TRICARE EAST SELECT - CPT - A9517","TRICARE EAST","TRICARE EAST SELECT","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.54,20.12,456.36,130.75,1]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 62323","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,717.03,420.34,1505.24,371.25,1]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 80069","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,10.46,7.66,456.36,48.75,1]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 84153","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,22.16,13.26,456.36,31.25,1]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 99385","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,101.62,23.27,530,132.5,1]
["TUFTS - TUFTS CARELINK - CPT - 19120","TUFTS","TUFTS CARELINK","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,5615.19,420.34,6229.57,1049.75,1]
["TUFTS - TUFTS CARELINK - CPT - 45391","TUFTS","TUFTS CARELINK","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1505.24,420.34,2924,731,1]
["TUFTS - TUFTS CARELINK - CPT - 77066","TUFTS","TUFTS CARELINK","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,390.48,131.5,924,231,1]
["TUFTS - TUFTS CARELINK - CPT - 99203","TUFTS","TUFTS CARELINK","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,27.28,23.27,456.36,103.75,1]
["TUFTS - TUFTS CARELINK - CPT - Q9967","TUFTS","TUFTS CARELINK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["TUFTS - TUFTS HMO - CPT - 66984","TUFTS","TUFTS HMO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,3587.95,420.34,4241.13,556,1]
["TUFTS - TUFTS HMO - CPT - 76700","TUFTS","TUFTS HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,332.11,111.92,961.35,282.75,1]
["TUFTS - TUFTS HMO - CPT - 85610","TUFTS","TUFTS HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,29,3.58,456.36,7.25,1]
["TUFTS - TUFTS HMO - CPT - A9513","TUFTS","TUFTS HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,289.33999999999997,154.44,456.36,107.25,1]
["TUFTS - TUFTS HMO - CPT - J3301","TUFTS","TUFTS HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["TUFTS - TUFTS POS - CPT - 66984","TUFTS","TUFTS POS","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,3587.95,420.34,4241.13,556,1]
["TUFTS - TUFTS POS - CPT - 81002","TUFTS","TUFTS POS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.93,2.34,456.36,4.25,1]
["TUFTS - TUFTS POS - CPT - 99213","TUFTS","TUFTS POS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,27.28,23.27,456.36,69.25,1]
["TUFTS - TUFTS POS - CPT - Q9967","TUFTS","TUFTS POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["TUFTS - TUFTS PPO - CPT - 55700","TUFTS","TUFTS PPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1505.24,420.34,3848.68,587,1]
["TUFTS - TUFTS PPO - CPT - 76805","TUFTS","TUFTS PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,352.8,113.99,1013.2,298,1]
["TUFTS - TUFTS PPO - CPT - 90837","TUFTS","TUFTS PPO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,32.64,27.84,456.36,53.75,1]
["TUFTS - TUFTS PPO - CPT - 99204","TUFTS","TUFTS PPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,27.28,23.27,705,176.25,1]
["TUFTS - TUFTS SELECT - CPT - 29881","TUFTS","TUFTS SELECT","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,5454,420.34,5454,1363.5,1]
["TUFTS - TUFTS SELECT - CPT - 70553","TUFTS","TUFTS SELECT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,458.44,398.75,5879.45,1729.25,1]
["TUFTS - TUFTS SELECT - CPT - 85610","TUFTS","TUFTS SELECT","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.43,3.58,456.36,7.25,1]
["TUFTS - TUFTS SELECT - CPT - 93452","TUFTS","TUFTS SELECT","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,6358,420.34,6358,1589.5,1]
["TUFTS - TUFTS SELECT - CPT - A9555","TUFTS","TUFTS SELECT","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["TUFTS - TUFTS SPIRIT - CPT - 45378","TUFTS","TUFTS SPIRIT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["TUFTS - TUFTS SPIRIT - CPT - 80055","TUFTS","TUFTS SPIRIT","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65,1]
["TUFTS - TUFTS SPIRIT - CPT - 90837","TUFTS","TUFTS SPIRIT","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75,1]
["TUFTS - TUFTS SPIRIT - CPT - 99212","TUFTS","TUFTS SPIRIT","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,37.01,23.27,456.36,36.75,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 19120","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,420.34,420.34,6229.57,1049.75,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 74177","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,420.34,398.75,2773.55,815.75,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 85610","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,5.12,3.58,456.36,7.25,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 99203","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,420.34,23.27,456.36,103.75,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - J1030","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,420.34,4.68,456.36,3.25,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 66984","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,420.34,420.34,4241.13,556,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 81003","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.68,1.63,456.36,4.25,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 85610","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,5.12,3.58,456.36,7.25,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - A9513","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,420.34,154.44,456.36,107.25,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - Q9967","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,420.34,0.12,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 80048","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,10.11,7.46,456.36,41.75,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 81002","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,4.16,2.34,456.36,4.25,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 99203","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,420.34,23.27,456.36,103.75,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - Q9967","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,420.34,0.12,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 70553","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,597.91999999999996,398.75,5879.45,1729.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 76805","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,170.93,113.99,1013.2,298,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 90847","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,247.88,30.9,456.36,90.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - P9047","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,73.5,50.13,456.36,45,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 64483","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,420.34,420.34,1879.97,386.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 73721","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,420.34,254.07,4304.3999999999996,1266,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 84443","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,20.079999999999998,14.82,456.36,28.5,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - A9575","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,420.34,0.13,456.36,2,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - Q9967","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,420.34,0.12,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 45385","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1834.71,420.34,2929.62,760,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 81000","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,5.57,2.89,456.36,6,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 85730","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,8.32,5.3,456.36,10.5,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - Q9967","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 45378","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,420.34,395.43,2154,538.5,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 80061","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,16,11.81,456.36,32.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 90847","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,420.34,30.9,456.36,90.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - A9555","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,420.34,420.34,1385,346.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - Q9963","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,420.34,0.22,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 77065","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 81003","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,3.12,1.63,456.36,4.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - A9500","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 19120","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,420.34,420.34,6229.57,1049.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 76700","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,420.34,111.92,961.35,282.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 81001","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.79,2.8,456.36,6,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 99203","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,420.34,23.27,456.36,103.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 99213","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,420.34,23.27,456.36,69.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - Q9967","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,420.34,0.12,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 76700","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,170.93,111.92,961.35,282.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 90846","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,247.88,30.9,456.36,77,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - A9575","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - Q9963","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 72193","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,420.34,190.5,2584,760,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 84153","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,21.97,13.26,456.36,31.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 99214","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,420.34,23.27,456.36,105.5,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - A9579","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,420.34,1.08,456.36,0.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 45380","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1834.71,420.34,2575,643.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 80076","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,11.31,7.21,456.36,40.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 81001","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,4.3899999999999997,2.8,456.36,6,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 99213","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,69.23,23.27,456.36,69.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 43239","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,420.34,420.34,1871.88,428,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 76805","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,420.34,113.99,1013.2,298,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 81000","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.8099999999999996,2.89,456.36,6,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 90847","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,420.34,30.9,456.36,90.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - Q9958","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,420.34,0.09,456.36,0.25,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 70553","TUFTS MEDICARE","TUFTS MEDICARE HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 76830","TUFTS MEDICARE","TUFTS MEDICARE HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 85730","TUFTS MEDICARE","TUFTS MEDICARE HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - A9579","TUFTS MEDICARE","TUFTS MEDICARE HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 62322","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 66821","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 81000","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 99212","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - J1030","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 76700","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 80048","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 90834","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - A9513","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - Q9967","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 72110","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 85730","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 99214","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 45378","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 64483","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 80076","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 99204","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - A9513","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 29881","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 76805","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 99203","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - P9047","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - Q9967","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["TUFTS TOGETHER ACO - TUFTS TOGETHER ACO CHA - CPT - 85730","TUFTS TOGETHER ACO","TUFTS TOGETHER ACO CHA","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS - CPT - 81003","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS - CPT - 80048","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH - CPT - 80069","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST - CPT - 85610","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH - CPT - 80048","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH CARE PLUS - CPT - 81003","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH CARE PLUS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH COMMONHLTH - CPT - 80048","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH COMMONHLTH","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH FAM ASSIST - CPT - 81003","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH FAM ASSIST","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH STANDARD - CPT - 85610","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO - CPT - 80076","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS - CPT - 81002","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST - CPT - 81002","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO STANDARD - CPT - 80076","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA CARE PLUS - CPT - 85610","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA CARE PLUS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA COMMONHLTH - CPT - 81003","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA COMMONHLTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA FAM ASSIST - CPT - 81002","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA FAM ASSIST","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY - CPT - 80053","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS - CPT - 80076","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY COMMONHLTH - CPT - 80076","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY COMMONHLTH","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST - CPT - 81000","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6,1]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY STANDARD - CPT - 81002","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO CARE PLUS - CPT - 80053","TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO CARE PLUS","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75,1]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - CPT - 80061","TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO FAMILY ASSIST","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25,1]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - CPT - 85025","TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO FAMILY ASSIST","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75,1]
["UBH HPHC - UBH HPHC - CPT - 45378","UBH HPHC","UBH HPHC","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["UBH HPHC - UBH HPHC - CPT - 76830","UBH HPHC","UBH HPHC","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["UBH HPHC - UBH HPHC - CPT - 90834","UBH HPHC","UBH HPHC","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75,1]
["UBH HPHC - UBH HPHC - CPT - 99212","UBH HPHC","UBH HPHC","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75,1]
["UBH HPHC - UBH HPHC - CPT - Q9967","UBH HPHC","UBH HPHC","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["UNICARE - UNICARE STANDARD - CPT - 74177","UNICARE","UNICARE STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,2447.25,398.75,2773.55,815.75,1]
["UNICARE - UNICARE STANDARD - CPT - 76830","UNICARE","UNICARE STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,132.9,113.99,873.8,257,1]
["UNICARE - UNICARE STANDARD - CPT - 90834","UNICARE","UNICARE STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,161.25,27.84,456.36,53.75,1]
["UNICARE - UNICARE STANDARD - CPT - J1030","UNICARE","UNICARE STANDARD","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.67,4.68,456.36,3.25,1]
["UNITED - UNITED DEFINITY HRA - CPT - 45380","UNITED","UNITED DEFINITY HRA","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,2575,420.34,2575,643.75,1]
["UNITED - UNITED DEFINITY HRA - CPT - 70553","UNITED","UNITED DEFINITY HRA","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,954.74,398.75,5879.45,1729.25,1]
["UNITED - UNITED DEFINITY HRA - CPT - 85610","UNITED","UNITED DEFINITY HRA","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.86,3.58,456.36,7.25,1]
["UNITED - UNITED DEFINITY HRA - CPT - 99213","UNITED","UNITED DEFINITY HRA","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["UNITED - UNITED HP SHIP - CPT - 43239","UNITED","UNITED HP SHIP","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1871.88,420.34,1871.88,428,1]
["UNITED - UNITED HP SHIP - CPT - 76805","UNITED","UNITED HP SHIP","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298,1]
["UNITED - UNITED HP SHIP - CPT - 80061","UNITED","UNITED HP SHIP","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,40.630000000000003,11.81,456.36,32.25,1]
["UNITED - UNITED HP SHIP - CPT - 99204","UNITED","UNITED HP SHIP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25,1]
["UNITED - UNITED HP SHIP - CPT - Q9967","UNITED","UNITED HP SHIP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["UNITED - UNITED HP SHIP - CPT - Q9967","UNITED","UNITED HP SHIP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 76830","UNITED","UNITED HP STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,220.4,113.99,873.8,257,1]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 85730","UNITED","UNITED HP STUDENT HEALTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,16.39,5.3,456.36,10.5,1]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 99204","UNITED","UNITED HP STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25,1]
["UNITED - UNITED NAVIGATE - CPT - 45378","UNITED","UNITED NAVIGATE","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,2154,395.43,2154,538.5,1]
["UNITED - UNITED NAVIGATE - CPT - 62323","UNITED","UNITED NAVIGATE","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1485,420.34,1505.24,371.25,1]
["UNITED - UNITED NAVIGATE - CPT - 85027","UNITED","UNITED NAVIGATE","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,5.82,5.71,456.36,11.25,1]
["UNITED - UNITED NAVIGATE - CPT - 99205","UNITED","UNITED NAVIGATE","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,328.17,23.27,899,224.75,1]
["UNITED - UNITED NAVIGATE - CPT - A9500","UNITED","UNITED NAVIGATE","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["UNITED - UNITED PASSPORT CONNECT - CPT - 45385","UNITED","UNITED PASSPORT CONNECT","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760,1]
["UNITED - UNITED PASSPORT CONNECT - CPT - 81001","UNITED","UNITED PASSPORT CONNECT","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,8.65,2.8,456.36,6,1]
["UNITED - UNITED PASSPORT CONNECT - CPT - 97110","UNITED","UNITED PASSPORT CONNECT","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,145.28,23.1,456.36,62.25,1]
["UNITED - UNITED PASSPORT CONNECT - CPT - A9581","UNITED","UNITED PASSPORT CONNECT","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["UNITED - UNITED PASSPORT CONNECT - CPT - Q9967","UNITED","UNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["UNITED - UNITED STANDARD - CPT - 62322","UNITED","UNITED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["UNITED - UNITED STANDARD - CPT - 85027","UNITED","UNITED STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,5.82,5.71,456.36,11.25,1]
["UNITED - UNITED STANDARD - CPT - 90834","UNITED","UNITED STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,215,27.84,456.36,53.75,1]
["UNITED - UNITED STANDARD - CPT - A9552","UNITED","UNITED STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 45378","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 81002","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 99204","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25,1]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 99214","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 19120","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 76830","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 80076","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - A9552","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - Q9967","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 74177","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 85025","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 90662","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - A9552","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 55700","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 70553","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 84153","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 99214","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 45378","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 76830","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 81002","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 93452","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - Q9967","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 19120","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 80053","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 90832","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - J3301","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - Q9967","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 70553","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 81002","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 99214","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - Q9963","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 45378","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,861.6,395.43,2154,538.5,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 80069","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,78,7.66,456.36,48.75,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 90853","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,51.6,15.63,456.36,32.25,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - A9555","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,554,420.34,1385,346.25,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - Q9967","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.4,0.12,456.36,0.25,1]
["WELLCARE - WELLCARE HMO - CPT - 72193","WELLCARE","WELLCARE HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,214.55,190.5,2584,760,1]
["WELLCARE - WELLCARE HMO - CPT - 90715","WELLCARE","WELLCARE HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["WELLCARE - WELLCARE HMO - CPT - A9517","WELLCARE","WELLCARE HMO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.19,20.12,456.36,130.75,1]
["WELLCARE - WELLCARE HMO - CPT - P9047","WELLCARE","WELLCARE HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,55.2,50.13,456.36,45,1]
["WELLCARE - WELLCARE PPO - CPT - 70553","WELLCARE","WELLCARE PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,449.08,398.75,5879.45,1729.25,1]
["WELLCARE - WELLCARE PPO - CPT - 80055","WELLCARE","WELLCARE PPO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,49.72,18.32,456.36,65,1]
["WELLCARE - WELLCARE PPO - CPT - 99215","WELLCARE","WELLCARE PPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,154.36000000000001,23.27,595,148.75,1]
["WELLCARE - WELLCARE PPO - CPT - A9579","WELLCARE","WELLCARE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["WELLCARE - WELLCARE STANDARD - CPT - 45380","WELLCARE","WELLCARE STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1377.99,420.34,2575,643.75,1]
["WELLCARE - WELLCARE STANDARD - CPT - 80048","WELLCARE","WELLCARE STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.8000000000000007,7.46,456.36,41.75,1]
["WELLCARE - WELLCARE STANDARD - CPT - 99203","WELLCARE","WELLCARE STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,154.36000000000001,23.27,456.36,103.75,1]
["WELLCARE - WELLCARE STANDARD - CPT - 99213","WELLCARE","WELLCARE STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,154.36000000000001,23.27,456.36,69.25,1]
["WELLSENSE - WELLSENSE CHOICE - CPT - 80061","WELLSENSE","WELLSENSE CHOICE","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,14.17,11.81,456.36,32.25,1]
["WELLSENSE - WELLSENSE CLARITY BRONZE - CPT - 81001","WELLSENSE","WELLSENSE CLARITY BRONZE","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.36,2.8,456.36,6,1]
["WELLSENSE - WELLSENSE CLARITY GOLD - CPT - 85730","WELLSENSE","WELLSENSE CLARITY GOLD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.36,5.3,456.36,10.5,1]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 1 - CPT - 81001","WELLSENSE","WELLSENSE CLARITY PLAN TYPE 1","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.36,2.8,456.36,6,1]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 81003","WELLSENSE","WELLSENSE CLARITY PLAN TYPE 2","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.38,1.63,456.36,4.25,1]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 81000","WELLSENSE","WELLSENSE CLARITY PLATINUM","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.26,2.89,456.36,6,1]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 81001","WELLSENSE","WELLSENSE CLARITY SILVER","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.36,2.8,456.36,6,1]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 85610","WELLSENSE","WELLSENSE CLARITY SILVER","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.54,3.58,456.36,7.25,1]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 81001","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO CHILDRENS","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6,1]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - CPT - 80048","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO EAST BOSTON","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75,1]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 80069","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO MERCY","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75,1]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 84153","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO MERCY","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.22,13.26,456.36,31.25,1]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - CPT - 80053","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO SOUTH COAST","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75,1]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 81002","WELLSENSE ALLI ACO","WELLSENSE CARE ALLIANCE","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 84153","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM CARE PLUS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.22,13.26,456.36,31.25,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 80053","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM COMMONHLTH","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 85730","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM FAM ASSIST","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 85610","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81002","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY COMMONHLTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81002","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY COMMONHLTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 84443","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 84443","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY CARE PLUS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 85610","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY COMMONHLTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 81000","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY FAM ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 81001","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 80055","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG COMMONHLTH","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 84443","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG FAM ASSIST","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 85025","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG FAM ASSIST","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 80055","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO CARE PLUS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 85730","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO COMMNHLTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 80055","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65,1]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81000","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO CARE PLUS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6,1]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 80061","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO COMMONHEALTH","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25,1]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 81000","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO FAMILY ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6,1]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 85730","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 72148","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,1667.88,254.07,3938.05,1158.25,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 77066","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,332.64,131.5,924,231,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 95810","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1416.6,420.34,3344.75,983.75,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - A9579","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,1.8,1.57,456.36,1.25,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - Q9967","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.36,0.12,456.36,0.25,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 66984","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 85025","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - A9513","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - A9581","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 55700","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 81002","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99203","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - A9555","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - Q9967","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 76830","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,131.47999999999999,113.99,873.8,257,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 81001","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,4.43,2.8,456.36,6,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 93452","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,2717.41,420.34,6358,1589.5,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - Q9963","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.43,0.22,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 62323","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,634.69000000000005,420.34,1505.24,371.25,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 77066","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,394.92,131.5,924,231,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 90686","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,31.63,19.16,456.36,18.5,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99385","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,226.52,23.27,530,132.5,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 45378","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,395.43,395.43,2154,538.5,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 76700","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,111.92,111.92,961.35,282.75,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 81000","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.43,2.89,456.36,6,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99212","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,41.58,23.27,456.36,36.75,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - Q9966","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,0.43,0.36,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 66984","WORKERS COMP","WORKERS COMP CCMSI","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,950.54,420.34,4241.13,556,1]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 77066","WORKERS COMP","WORKERS COMP CCMSI","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,394.92,131.5,924,231,1]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 90715","WORKERS COMP","WORKERS COMP CCMSI","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,76.930000000000007,39.75,456.36,45,1]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 99215","WORKERS COMP","WORKERS COMP CCMSI","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,132.82,23.27,595,148.75,1]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 66821","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1201.42,420.34,2389.35,702.75,1]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 66984","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,950.54,420.34,4241.13,556,1]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 85025","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,10.86,6.85,456.36,13.75,1]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 99204","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 19120","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,1794.65,420.34,6229.57,1049.75,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 45391","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1249.72,420.34,2924,731,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 77067","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,208.57,108.47,488,122,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 93452","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,2717.41,420.34,6358,1589.5,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - J1030","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,5.56,4.68,456.36,3.25,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - Q9967","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 76700","WORKERS COMP","WORKERS COMP COVE RISK","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,111.92,111.92,961.35,282.75,1]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 85730","WORKERS COMP","WORKERS COMP COVE RISK","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,8.3800000000000008,5.3,456.36,10.5,1]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - A9513","WORKERS COMP","WORKERS COMP COVE RISK","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,183.35,154.44,456.36,107.25,1]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - J3301","WORKERS COMP","WORKERS COMP COVE RISK","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,7.69,0.98,456.36,4.5,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 55700","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1003.54,420.34,3848.68,587,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 84443","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,23.47,14.82,456.36,28.5,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 99203","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,100,23.27,456.36,103.75,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 99214","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,98.77,23.27,456.36,105.5,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 45378","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,395.43,395.43,2154,538.5,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 76805","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,114.99,113.99,1013.2,298,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 90837","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,91.89,27.84,456.36,53.75,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 99204","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - Q9967","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 70553","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,2956.33,398.75,5879.45,1729.25,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 81002","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.57,2.34,456.36,4.25,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 85730","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,8.3800000000000008,5.3,456.36,10.5,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - Q9963","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.43,0.22,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 45378","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,395.43,395.43,2154,538.5,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 80055","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,111.12,18.32,456.36,65,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 90846","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,131.63999999999999,30.9,456.36,77,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - A9552","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,433.81,365.4,1015,253.75,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - Q9967","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 72110","WORKERS COMP","WORKERS COMP MBTA","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,46.45,46.45,595,148.75,1]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 76830","WORKERS COMP","WORKERS COMP MBTA","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,131.47999999999999,113.99,873.8,257,1]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 90662","WORKERS COMP","WORKERS COMP MBTA","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,55.13,36.119999999999997,456.36,32.25,1]
["WORKERS COMP - WORKERS COMP MBTA - CPT - A9575","WORKERS COMP","WORKERS COMP MBTA","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,3.42,0.13,456.36,2,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 62322","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,609.47,82.95,1426,356.5,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 77065","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,321.39999999999998,102.59,752,188,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 84153","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,25.7,13.26,456.36,31.25,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 99215","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,132.82,23.27,595,148.75,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - Q9967","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,0.85,0.12,456.36,0.5,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 76700","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,111.92,111.92,961.35,282.75,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 77065","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,321.39999999999998,102.59,752,188,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 93452","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,2717.41,420.34,6358,1589.5,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - Q9963","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.43,0.22,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 66821","WORKERS COMP","WORKERS COMP STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1201.42,420.34,2389.35,702.75,1]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 73721","WORKERS COMP","WORKERS COMP STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,578.29999999999995,254.07,4304.3999999999996,1266,1]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 90686","WORKERS COMP","WORKERS COMP STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,31.63,19.16,456.36,18.5,1]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 99385","WORKERS COMP","WORKERS COMP STANDARD","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,226.52,23.27,530,132.5,1]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - J3301","WORKERS COMP","WORKERS COMP STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,7.69,0.98,456.36,4.5,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 45385","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1299.3,420.34,2929.62,760,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 81000","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.43,2.89,456.36,6,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 99212","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,41.58,23.27,456.36,36.75,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - Q9967","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,0.85,0.12,456.36,0.5,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 19120","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,1794.65,420.34,6229.57,1049.75,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 77066","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,394.92,131.5,924,231,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 90853","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,55.13,15.63,456.36,32.25,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 99203","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,100,23.27,456.36,103.75,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - J1030","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,5.56,4.68,456.36,3.25,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 66984","WORKERS COMP","ZZZWORKERS COMP AIG","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,950.54,420.34,4241.13,556,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 77066","WORKERS COMP","ZZZWORKERS COMP AIG","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,394.92,131.5,924,231,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 99213","WORKERS COMP","ZZZWORKERS COMP AIG","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,65.91,23.27,456.36,69.25,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - A9513","WORKERS COMP","ZZZWORKERS COMP AIG","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,183.35,154.44,456.36,107.25,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 29881","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2331.04,420.34,5454,1363.5,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 72193","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,332.53,190.5,2584,760,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 81002","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.57,2.34,456.36,4.25,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99203","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,100,23.27,456.36,103.75,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - Q9967","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 66984","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,950.54,420.34,4241.13,556,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 85610","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,5.49,3.58,456.36,7.25,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 90837","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,91.89,27.84,456.36,53.75,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - Q9967","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 55700","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1003.54,420.34,3848.68,587,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 70553","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,2956.33,398.75,5879.45,1729.25,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 81002","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.57,2.34,456.36,4.25,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99204","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - Q9967","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 76805","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,114.99,113.99,1013.2,298,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 80055","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,111.12,18.32,456.36,65,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 90837","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,91.89,27.84,456.36,53.75,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - Q9958","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,0.43,0.09,456.36,0.25,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - Q9967","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 72110","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,46.45,46.45,595,148.75,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 85730","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,8.3800000000000008,5.3,456.36,10.5,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99215","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,132.82,23.27,595,148.75,1]
["ZZZAETNA - ZZZAETNA HMO - CPT - 45378","ZZZAETNA","ZZZAETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5,1]
["ZZZAETNA - ZZZAETNA HMO - CPT - 62322","ZZZAETNA","ZZZAETNA HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5,1]
["ZZZAETNA - ZZZAETNA HMO - CPT - 81002","ZZZAETNA","ZZZAETNA HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25,1]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99205","ZZZAETNA","ZZZAETNA HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99215","ZZZAETNA","ZZZAETNA HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 19120","ZZZAETNA","ZZZAETNA MCR SUPP","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 76830","ZZZAETNA","ZZZAETNA MCR SUPP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 90662","ZZZAETNA","ZZZAETNA MCR SUPP","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - A9575","ZZZAETNA","ZZZAETNA MCR SUPP","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - Q9967","ZZZAETNA","ZZZAETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZAETNA - ZZZAETNA POS - CPT - 64483","ZZZAETNA","ZZZAETNA POS","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25,1]
["ZZZAETNA - ZZZAETNA POS - CPT - 84153","ZZZAETNA","ZZZAETNA POS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25,1]
["ZZZAETNA - ZZZAETNA POS - CPT - 99205","ZZZAETNA","ZZZAETNA POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75,1]
["ZZZAETNA - ZZZAETNA POS - CPT - J1030","ZZZAETNA","ZZZAETNA POS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 45380","ZZZAETNA","ZZZAETNA PPO-EPO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 77065","ZZZAETNA","ZZZAETNA PPO-EPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 93452","ZZZAETNA","ZZZAETNA PPO-EPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - A9552","ZZZAETNA","ZZZAETNA PPO-EPO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - Q9967","ZZZAETNA","ZZZAETNA PPO-EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 73721","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 84443","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99213","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - A9581","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,52.37,15.3,456.36,24.75,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 45385","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1299.3,420.34,2929.62,760,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 77065","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,321.39999999999998,102.59,752,188,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 85027","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,9.0399999999999991,5.71,456.36,11.25,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99213","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,65.91,23.27,456.36,69.25,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 19120","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4493.84,420.34,6229.57,1049.75,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 72148","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,288.89,254.07,3938.05,1158.25,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 80048","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.8800000000000008,7.46,456.36,41.75,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99204","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,155.85,23.27,705,176.25,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - Q9963","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 70553","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,453.39,398.75,5879.45,1729.25,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 81003","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 90715","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - J1030","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 62323","ZZZCIGNA","CIGNA LOCALPLUS","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1262.25,420.34,1505.24,371.25,1]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 70553","ZZZCIGNA","CIGNA LOCALPLUS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,5879.45,398.75,5879.45,1729.25,1]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 85610","ZZZCIGNA","CIGNA LOCALPLUS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.34,3.58,456.36,7.25,1]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99214","ZZZCIGNA","CIGNA LOCALPLUS","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,358.7,23.27,456.36,105.5,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 43235","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1505.24,420.34,1871.88,376.25,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 76700","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,353.57,111.92,961.35,282.75,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 80053","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,28.89,9.31,456.36,67.75,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99205","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,27.28,23.27,899,224.75,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - P9047","ZZZCIGNA","ZZZCIGNA CARELINK","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,57.24,50.13,456.36,45,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - Q9967","ZZZCIGNA","ZZZCIGNA CARELINK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 70553","ZZZCIGNA","ZZZCIGNA STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,5879.45,398.75,5879.45,1729.25,1]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 90846","ZZZCIGNA","ZZZCIGNA STANDARD","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,261.8,30.9,456.36,77,1]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - A9552","ZZZCIGNA","ZZZCIGNA STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,862.75,365.4,1015,253.75,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 43239","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,731.71,420.34,1871.88,428,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 62322","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,609.47,82.95,1426,356.5,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 76830","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,131.47999999999999,113.99,873.8,257,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99204","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99215","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,132.82,23.27,595,148.75,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - Q9967","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,0.43,0.12,456.36,0.25,1]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 72110","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75,1]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 90847","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75,1]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - A9579","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 43239","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1871.88,420.34,1871.88,428,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 73721","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,451.66,254.07,4304.3999999999996,1266,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 84443","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,51,14.82,456.36,28.5,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 90715","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - Q9967","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 45385","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 81000","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,9.8800000000000008,2.89,456.36,6,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 95810","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2243.64,420.34,3344.75,983.75,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99204","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - Q9967","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 74177","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,755.93,398.75,2773.55,815.75,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 77067","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,488,108.47,488,122,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 90837","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,108.15,27.84,456.36,53.75,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - J1030","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 66984","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,4241.13,420.34,4241.13,556,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 81000","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,9.8800000000000008,2.89,456.36,6,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 85730","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,16.39,5.3,456.36,10.5,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99213","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 29881","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 55700","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 80053","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 99203","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - Q9958","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 43235","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1505,420.34,1871.88,376.25,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 76830","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,272.94,113.99,873.8,257,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 85730","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.41,5.3,456.36,10.5,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - A9579","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - Q9967","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 66821","ZZZUNITED","ZZZUNITED HP SHIP","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1219.6099999999999,420.34,2389.35,702.75,1]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 84443","ZZZUNITED","ZZZUNITED HP SHIP","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,51,14.82,456.36,28.5,1]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 99212","ZZZUNITED","ZZZUNITED HP SHIP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75,1]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - Q9963","ZZZUNITED","ZZZUNITED HP SHIP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 45385","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 77066","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,924,131.5,924,231,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 85610","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99212","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99213","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99213","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99214","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,422,23.27,456.36,105.5,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99214","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,422,23.27,456.36,105.5,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99215","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99215","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99385","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,266.58999999999997,23.27,530,132.5,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99386","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,321.92,23.27,640,160,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9500","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9513","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,285.07,154.44,456.36,107.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9517","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,36.409999999999997,20.12,456.36,130.75,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9552","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9555","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9575","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9579","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9579","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9581","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - J1030","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - J3301","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - P9047","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,52.45,50.13,456.36,45,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9958","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9963","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9963","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9966","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 19120","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,6229.57,420.34,6229.57,1049.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 29881","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,5454,420.34,5454,1363.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 43235","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1871.88,420.34,1871.88,376.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 43239","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1871.88,420.34,1871.88,428,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45378","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45378","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45378","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45380","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,2408.3200000000002,420.34,2575,643.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45385","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45391","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,2408.3200000000002,420.34,2924,731,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 55700","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,3848.68,420.34,3848.68,587,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 55700","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,3848.68,420.34,3848.68,587,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 62322","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 62322","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 62323","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1471.87,420.34,1505.24,371.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 64483","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1879.97,420.34,1879.97,386.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 66821","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1219.6099999999999,420.34,2389.35,702.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 66984","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,4241.13,420.34,4241.13,556,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 70450","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,220.4,113.99,1718.7,505.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 70553","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,755.93,398.75,5879.45,1729.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 70553","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,755.93,398.75,5879.45,1729.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 72110","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,595,46.45,595,148.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 72148","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,451.66,254.07,3938.05,1158.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 72193","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,395.2,190.5,2584,760,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 73721","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,451.66,254.07,4304.3999999999996,1266,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 74177","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,755.93,398.75,2773.55,815.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76700","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,220.4,111.92,961.35,282.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76700","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,220.4,111.92,961.35,282.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76805","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76805","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76830","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,220.4,113.99,873.8,257,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76830","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,220.4,113.99,873.8,257,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 77065","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,752,102.59,752,188,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 77066","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,924,131.5,924,231,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 77067","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,488,108.47,488,122,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80048","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,25.66,7.46,456.36,41.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80053","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,32.049999999999997,9.31,456.36,67.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80055","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,130.57,18.32,456.36,65,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80061","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,40.630000000000003,11.81,456.36,32.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80069","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,26.35,7.66,456.36,48.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80076","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,22.32,7.21,456.36,40.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81000","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,9.8800000000000008,2.89,456.36,6,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81000","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,9.8800000000000008,2.89,456.36,6,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81001","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,8.65,2.8,456.36,6,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81002","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.5500000000000007,2.34,456.36,4.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81002","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.5500000000000007,2.34,456.36,4.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81003","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,6.81,1.63,456.36,4.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81003","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,6.81,1.63,456.36,4.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 84153","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,50.24,13.26,456.36,31.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 84443","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,51,14.82,456.36,28.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85025","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,21.21,6.85,456.36,13.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85027","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,17.649999999999999,5.71,456.36,11.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85610","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85610","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85730","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,16.39,5.3,456.36,10.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85730","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,16.39,5.3,456.36,10.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90662","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,73.400000000000006,36.119999999999997,456.36,32.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90686","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,22.35,19.16,456.36,18.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90715","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90832","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,84.5,21.97,456.36,42,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90834","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,108.15,27.84,456.36,53.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90837","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,108.15,27.84,456.36,53.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90846","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,154.91999999999999,30.9,456.36,77,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90847","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,182.59,30.9,456.36,90.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90853","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,64.89,15.63,456.36,32.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 93452","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,6358,420.34,6358,1589.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 95810","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2243.64,420.34,3344.75,983.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 97110","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,145.28,23.1,456.36,62.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99203","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,415,23.27,456.36,103.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99203","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,415,23.27,456.36,103.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99204","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99204","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99205","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99205","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99212","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99212","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99213","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99213","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99214","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,422,23.27,456.36,105.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99214","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,422,23.27,456.36,105.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99215","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99215","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99385","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,266.58999999999997,23.27,530,132.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99386","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,321.92,23.27,640,160,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9500","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9513","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,285.07,154.44,456.36,107.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9517","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,36.409999999999997,20.12,456.36,130.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9552","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9555","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9575","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9579","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9579","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9581","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - J1030","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - J3301","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - P9047","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,52.45,50.13,456.36,45,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9958","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9963","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9963","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9966","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 19120","ZZZUNITED","ZZZUNITED STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4199,420.34,6229.57,1049.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 29881","ZZZUNITED","ZZZUNITED STANDARD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 43235","ZZZUNITED","ZZZUNITED STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1505,420.34,1871.88,376.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 43239","ZZZUNITED","ZZZUNITED STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1712,420.34,1871.88,428,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45378","ZZZUNITED","ZZZUNITED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,2154,395.43,2154,538.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45378","ZZZUNITED","ZZZUNITED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,2154,395.43,2154,538.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45378","ZZZUNITED","ZZZUNITED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,2154,395.43,2154,538.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45380","ZZZUNITED","ZZZUNITED STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,2575,420.34,2575,643.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45385","ZZZUNITED","ZZZUNITED STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2929.62,420.34,2929.62,760,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45391","ZZZUNITED","ZZZUNITED STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,2924,420.34,2924,731,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 55700","ZZZUNITED","ZZZUNITED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2348,420.34,3848.68,587,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 55700","ZZZUNITED","ZZZUNITED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2348,420.34,3848.68,587,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 62322","ZZZUNITED","ZZZUNITED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 62322","ZZZUNITED","ZZZUNITED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 62323","ZZZUNITED","ZZZUNITED STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1485,420.34,1505.24,371.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 64483","ZZZUNITED","ZZZUNITED STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1545,420.34,1879.97,386.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 66821","ZZZUNITED","ZZZUNITED STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1443.05,420.34,2389.35,702.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 66984","ZZZUNITED","ZZZUNITED STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2224,420.34,4241.13,556,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 70450","ZZZUNITED","ZZZUNITED STANDARD","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,272.94,113.99,1718.7,505.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 70553","ZZZUNITED","ZZZUNITED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,954.74,398.75,5879.45,1729.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 70553","ZZZUNITED","ZZZUNITED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,954.74,398.75,5879.45,1729.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 72110","ZZZUNITED","ZZZUNITED STANDARD","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,272.94,46.45,595,148.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 72148","ZZZUNITED","ZZZUNITED STANDARD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,608.33000000000004,254.07,3938.05,1158.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 72193","ZZZUNITED","ZZZUNITED STANDARD","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,456.13,190.5,2584,760,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 73721","ZZZUNITED","ZZZUNITED STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,608.33000000000004,254.07,4304.3999999999996,1266,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 74177","ZZZUNITED","ZZZUNITED STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,954.74,398.75,2773.55,815.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76700","ZZZUNITED","ZZZUNITED STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,272.94,111.92,961.35,282.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76700","ZZZUNITED","ZZZUNITED STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,272.94,111.92,961.35,282.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76805","ZZZUNITED","ZZZUNITED STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,272.94,113.99,1013.2,298,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76805","ZZZUNITED","ZZZUNITED STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,272.94,113.99,1013.2,298,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76830","ZZZUNITED","ZZZUNITED STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,272.94,113.99,873.8,257,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76830","ZZZUNITED","ZZZUNITED STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,272.94,113.99,873.8,257,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 77065","ZZZUNITED","ZZZUNITED STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,153.79,102.59,752,188,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 77066","ZZZUNITED","ZZZUNITED STANDARD","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,196.42,131.5,924,231,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 77067","ZZZUNITED","ZZZUNITED STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,162.43,108.47,488,122,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80048","ZZZUNITED","ZZZUNITED STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.61,7.46,456.36,41.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80053","ZZZUNITED","ZZZUNITED STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.5,9.31,456.36,67.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80055","ZZZUNITED","ZZZUNITED STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,43.03,18.32,456.36,65,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80061","ZZZUNITED","ZZZUNITED STANDARD","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,12.05,11.81,456.36,32.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80069","ZZZUNITED","ZZZUNITED STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.81,7.66,456.36,48.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80076","ZZZUNITED","ZZZUNITED STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.35,7.21,456.36,40.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81000","ZZZUNITED","ZZZUNITED STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.62,2.89,456.36,6,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81000","ZZZUNITED","ZZZUNITED STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.62,2.89,456.36,6,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81001","ZZZUNITED","ZZZUNITED STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.85,2.8,456.36,6,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81002","ZZZUNITED","ZZZUNITED STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.13,2.34,456.36,4.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81002","ZZZUNITED","ZZZUNITED STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.13,2.34,456.36,4.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81003","ZZZUNITED","ZZZUNITED STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.0299999999999998,1.63,456.36,4.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81003","ZZZUNITED","ZZZUNITED STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.0299999999999998,1.63,456.36,4.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 84153","ZZZUNITED","ZZZUNITED STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.55,13.26,456.36,31.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 84443","ZZZUNITED","ZZZUNITED STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,15.12,14.82,456.36,28.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85025","ZZZUNITED","ZZZUNITED STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.99,6.85,456.36,13.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85027","ZZZUNITED","ZZZUNITED STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,5.82,5.71,456.36,11.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85610","ZZZUNITED","ZZZUNITED STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.86,3.58,456.36,7.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85610","ZZZUNITED","ZZZUNITED STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.86,3.58,456.36,7.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85730","ZZZUNITED","ZZZUNITED STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.41,5.3,456.36,10.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85730","ZZZUNITED","ZZZUNITED STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.41,5.3,456.36,10.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90662","ZZZUNITED","ZZZUNITED STANDARD","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,57.77,36.119999999999997,456.36,32.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90686","ZZZUNITED","ZZZUNITED STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,19.16,19.16,456.36,18.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90715","ZZZUNITED","ZZZUNITED STANDARD","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90832","ZZZUNITED","ZZZUNITED STANDARD","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,168,21.97,456.36,42,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90834","ZZZUNITED","ZZZUNITED STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,215,27.84,456.36,53.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90837","ZZZUNITED","ZZZUNITED STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,215,27.84,456.36,53.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90846","ZZZUNITED","ZZZUNITED STANDARD","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,308,30.9,456.36,77,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90847","ZZZUNITED","ZZZUNITED STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,363,30.9,456.36,90.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90853","ZZZUNITED","ZZZUNITED STANDARD","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,129,15.63,456.36,32.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 93452","ZZZUNITED","ZZZUNITED STANDARD","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 95810","ZZZUNITED","ZZZUNITED STANDARD","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2595.64,420.34,3344.75,983.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 97110","ZZZUNITED","ZZZUNITED STANDARD","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99203","ZZZUNITED","ZZZUNITED STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,328.17,23.27,456.36,103.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99203","ZZZUNITED","ZZZUNITED STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,328.17,23.27,456.36,103.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99204","ZZZUNITED","ZZZUNITED STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,328.17,23.27,705,176.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99204","ZZZUNITED","ZZZUNITED STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,328.17,23.27,705,176.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99205","ZZZUNITED","ZZZUNITED STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,328.17,23.27,899,224.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99205","ZZZUNITED","ZZZUNITED STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,328.17,23.27,899,224.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99212","ZZZUNITED","ZZZUNITED STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99212","ZZZUNITED","ZZZUNITED STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99213","ZZZUNITED","ZZZUNITED STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99213","ZZZUNITED","ZZZUNITED STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99214","ZZZUNITED","ZZZUNITED STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,328.17,23.27,456.36,105.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99214","ZZZUNITED","ZZZUNITED STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,328.17,23.27,456.36,105.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99215","ZZZUNITED","ZZZUNITED STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,328.17,23.27,595,148.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99215","ZZZUNITED","ZZZUNITED STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,328.17,23.27,595,148.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9500","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9513","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,429,154.44,456.36,107.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9517","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,55.6,20.12,456.36,130.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9552","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9555","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9575","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9579","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",5,5,1.57,456.36,1.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9579","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",3,3,1.08,456.36,0.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9581","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - J1030","ZZZUNITED","ZZZUNITED STANDARD","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - J3301","ZZZUNITED","ZZZUNITED STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - P9047","ZZZUNITED","ZZZUNITED STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,138.30000000000001,50.13,456.36,45,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9958","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9963","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9963","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9966","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",2,2,0.12,456.36,0.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]

{"sheet":"PayerBillCodeCount (CPT)","index":11,"n_rows":4349,"n_cols":7,"rows_kept":2250,"cut":true,"hidden":true,"merged":[[0,0,0,1],[0,5,0,6]],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
["Unique Payer + CPT combination",null,null,null,null,"Bill Code Count per Payer"]
["Payer","Bill Code & Description",null,null,null,"Payer","Count of Bill Code & Description"]
["AARP UHC MEDICARE COMPLETE","19120 - PR EXCISE BREAST CYST",null,null,null,"TUFTS",79]
["AARP UHC MEDICARE COMPLETE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",null,null,null,"ZZZBU EMPLOYEE WORK COMP",79]
["AARP UHC MEDICARE COMPLETE","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",null,null,null,"UPHAMS CORNER ESP",79]
["AARP UHC MEDICARE COMPLETE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",null,null,null,"AETNA",79]
["AARP UHC MEDICARE COMPLETE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL",79]
["AARP UHC MEDICARE COMPLETE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",null,null,null,"BCBS",79]
["AARP UHC MEDICARE COMPLETE","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",null,null,null,"UNICARE",79]
["AARP UHC MEDICARE COMPLETE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",null,null,null,"BCBS OUT OF STATE",79]
["AARP UHC MEDICARE COMPLETE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",null,null,null,"WORKERS COMP",79]
["AARP UHC MEDICARE COMPLETE","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",null,null,null,"CIGNA",79]
["AARP UHC MEDICARE COMPLETE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",null,null,null,"ZZZCITY OF BOSTON WORK COMP",79]
["AARP UHC MEDICARE COMPLETE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",null,null,null,"FALLON",79]
["AARP UHC MEDICARE COMPLETE","66821 - PR DISCISSION,2ND CATARACT,LASER",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME",79]
["AARP UHC MEDICARE COMPLETE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",null,null,null,"HARVARD PILGRIM HEALTH CARE",79]
["AARP UHC MEDICARE COMPLETE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",null,null,null,"TUFTS CONNCARE/QHP",79]
["AARP UHC MEDICARE COMPLETE","70553 - CHG MRI BRAIN COMBO",null,null,null,"HEALTH PLANS INC",79]
["AARP UHC MEDICARE COMPLETE","72110 - CHG X-RAY LUMBAR SPINE 4 VW",null,null,null,"UNITED",79]
["AARP UHC MEDICARE COMPLETE","72148 - CHG MRI, LUMBAR SPINE",null,null,null,"HSN",79]
["AARP UHC MEDICARE COMPLETE","72193 - CHG CT SCAN OF PELVIS CONTRAST",null,null,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE",79]
["AARP UHC MEDICARE COMPLETE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",null,null,null,"HSN BAD DEBT",79]
["AARP UHC MEDICARE COMPLETE","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",null,null,null,"ZZZAETNA",79]
["AARP UHC MEDICARE COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",null,null,null,"HSN CONFIDENTIAL",79]
["AARP UHC MEDICARE COMPLETE","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",null,null,null,"ZZZCIGNA",79]
["AARP UHC MEDICARE COMPLETE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",null,null,null,"HSN DENTAL",79]
["AARP UHC MEDICARE COMPLETE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",null,null,null,"ZZZHEALTH PLANS INC",79]
["AARP UHC MEDICARE COMPLETE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",null,null,null,"HSN PARTIAL",79]
["AARP UHC MEDICARE COMPLETE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",null,null,null,"ZZZUNITED",79]
["AARP UHC MEDICARE COMPLETE","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",null,null,null,"TRICARE FOR LIFE",77]
["AARP UHC MEDICARE COMPLETE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",null,null,null,"AARP UHC MEDICARE COMPLETE",77]
["AARP UHC MEDICARE COMPLETE","80055 - CHG OBSTETRIC PANEL",null,null,null,"FALLON SCO",77]
["AARP UHC MEDICARE COMPLETE","80061 - CHG LIPID PANEL",null,null,null,"TUFTS MEDICARE",77]
["AARP UHC MEDICARE COMPLETE","80069 - CHG RENAL FUNCTION PANEL",null,null,null,"OXFORD HEALTH",77]
["AARP UHC MEDICARE COMPLETE","80076 - CHG HEPATIC FUNCTION PANEL",null,null,null,"TUFTS MEDICARE MANAGED",77]
["AARP UHC MEDICARE COMPLETE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",null,null,null,"BCBS MEDICARE MANAGED",77]
["AARP UHC MEDICARE COMPLETE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",null,null,null,"UBH HPHC",77]
["AARP UHC MEDICARE COMPLETE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",null,null,null,"WELLSENSE MEDICARE MANAGED",77]
["AARP UHC MEDICARE COMPLETE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",null,null,null,"HPHC MEDICARE MANAGED",77]
["AARP UHC MEDICARE COMPLETE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",null,null,null,"ZZZRAILROAD MEDICARE",77]
["AARP UHC MEDICARE COMPLETE","84443 - CHG ASSAY THYROID STIM HORMONE",null,null,null,"HUMANA MEDICARE",77]
["AARP UHC MEDICARE COMPLETE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",null,null,null,"TRICARE EAST",77]
["AARP UHC MEDICARE COMPLETE","85027 - CHG COMPLETE CBC",null,null,null,"UNITED COMMUNITY PLAN",77]
["AARP UHC MEDICARE COMPLETE","85610 - CHG PROTHROMBIN TIME",null,null,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND",77]
["AARP UHC MEDICARE COMPLETE","85730 - CHG THROMBOPLAS TIME PARTIAL",null,null,null,"UNITED MEDICARE MANAGED",77]
["AARP UHC MEDICARE COMPLETE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",null,null,null,"AETNA MEDICARE MANAGED",77]
["AARP UHC MEDICARE COMPLETE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",null,null,null,"FALLON MEDICARE MANAGED",77]
["AARP UHC MEDICARE COMPLETE","90715 - PR TDAP VACCINE >7 YO, IM",null,null,null,"NEIGHBORHOOD PACE",77]
["AARP UHC MEDICARE COMPLETE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",null,null,null,"MEDICARE",77]
["AARP UHC MEDICARE COMPLETE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",null,null,null,"CCA",75]
["AARP UHC MEDICARE COMPLETE","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",null,null,null,"CORRECTIONS",75]
["AARP UHC MEDICARE COMPLETE","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",null,null,null,"ZZZCCA ONECARE",75]
["AARP UHC MEDICARE COMPLETE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",null,null,null,"CCA MEDICARE PREFERRED",75]
["AARP UHC MEDICARE COMPLETE","90853 - PR GROUP PSYCHOTHERAPY",null,null,null,"WELLCARE",75]
["AARP UHC MEDICARE COMPLETE","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",null,null,null,"SENIOR WHOLE HEALTH",75]
["AARP UHC MEDICARE COMPLETE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",null,null,null,"FALLON HEALTHCRE ACO",16]
["AARP UHC MEDICARE COMPLETE","97110 - PR THERAPEUTIC EXERCISES",null,null,null,"TUFTS TOGETHER MCO",16]
["AARP UHC MEDICARE COMPLETE","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",null,null,null,"MEDICAID",16]
["AARP UHC MEDICARE COMPLETE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",null,null,null,"WELLSENSE ESSENTIAL MCO",16]
["AARP UHC MEDICARE COMPLETE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED",16]
["AARP UHC MEDICARE COMPLETE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",null,null,null,"MEDICAID ACO",16]
["AARP UHC MEDICARE COMPLETE","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",null,null,null,"WELLSENSE",16]
["AARP UHC MEDICARE COMPLETE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",null,null,null,"MEDICAID LIMITED",16]
["AARP UHC MEDICARE COMPLETE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",null,null,null,"TUFTS TOGETHER ACO",16]
["AARP UHC MEDICARE COMPLETE","A9500 - PR TC99M SESTAMIBI",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN ACO",16]
["AARP UHC MEDICARE COMPLETE","A9513 - DELETED 2077",null,null,null,"WELLSENSE ALLI ACO",16]
["AARP UHC MEDICARE COMPLETE","A9517 - PR I131 IODIDE CAP, RX",null,null,null,"HLTH NEW ENGLAND ACO",16]
["AARP UHC MEDICARE COMPLETE","A9552 - PR F18 FDG",null,null,null,"MEDICAID MANAGED CARE",16]
["AARP UHC MEDICARE COMPLETE","A9555 - PR RB82 RUBIDIUM",null,null,null,"FALLON MEDICAID MANAGED",16]
["AARP UHC MEDICARE COMPLETE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",null,null,null,"Grand Total",4347]
["AARP UHC MEDICARE COMPLETE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["AARP UHC MEDICARE COMPLETE","A9581 - PR GADOXETATE DISODIUM INJ"]
["AARP UHC MEDICARE COMPLETE","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["AARP UHC MEDICARE COMPLETE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AARP UHC MEDICARE COMPLETE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AARP UHC MEDICARE COMPLETE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["AARP UHC MEDICARE COMPLETE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["AARP UHC MEDICARE COMPLETE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["AARP UHC MEDICARE COMPLETE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["AETNA","19120 - PR EXCISE BREAST CYST"]
["AETNA","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["AETNA","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["AETNA","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["AETNA","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["AETNA","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["AETNA","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["AETNA","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["AETNA","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["AETNA","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["AETNA","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["AETNA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["AETNA","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["AETNA","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["AETNA","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["AETNA","70553 - CHG MRI BRAIN COMBO"]
["AETNA","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["AETNA","72148 - CHG MRI, LUMBAR SPINE"]
["AETNA","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["AETNA","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["AETNA","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["AETNA","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["AETNA","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["AETNA","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["AETNA","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["AETNA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["AETNA","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["AETNA","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["AETNA","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["AETNA","80055 - CHG OBSTETRIC PANEL"]
["AETNA","80061 - CHG LIPID PANEL"]
["AETNA","80069 - CHG RENAL FUNCTION PANEL"]
["AETNA","80076 - CHG HEPATIC FUNCTION PANEL"]
["AETNA","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["AETNA","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["AETNA","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["AETNA","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["AETNA","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["AETNA","84443 - CHG ASSAY THYROID STIM HORMONE"]
["AETNA","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["AETNA","85027 - CHG COMPLETE CBC"]
["AETNA","85610 - CHG PROTHROMBIN TIME"]
["AETNA","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["AETNA","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["AETNA","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["AETNA","90715 - PR TDAP VACCINE >7 YO, IM"]
["AETNA","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["AETNA","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["AETNA","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["AETNA","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["AETNA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["AETNA","90853 - PR GROUP PSYCHOTHERAPY"]
["AETNA","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["AETNA","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["AETNA","97110 - PR THERAPEUTIC EXERCISES"]
["AETNA","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["AETNA","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["AETNA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["AETNA","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["AETNA","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["AETNA","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["AETNA","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["AETNA","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["AETNA","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["AETNA","A9500 - PR TC99M SESTAMIBI"]
["AETNA","A9513 - DELETED 2077"]
["AETNA","A9517 - PR I131 IODIDE CAP, RX"]
["AETNA","A9552 - PR F18 FDG"]
["AETNA","A9555 - PR RB82 RUBIDIUM"]
["AETNA","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["AETNA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["AETNA","A9581 - PR GADOXETATE DISODIUM INJ"]
["AETNA","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["AETNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AETNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AETNA","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["AETNA","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["AETNA","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["AETNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["AETNA MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["AETNA MEDICARE MANAGED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["AETNA MEDICARE MANAGED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["AETNA MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["AETNA MEDICARE MANAGED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["AETNA MEDICARE MANAGED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["AETNA MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["AETNA MEDICARE MANAGED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["AETNA MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["AETNA MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["AETNA MEDICARE MANAGED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["AETNA MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["AETNA MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["AETNA MEDICARE MANAGED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["AETNA MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["AETNA MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["AETNA MEDICARE MANAGED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["AETNA MEDICARE MANAGED","72148 - CHG MRI, LUMBAR SPINE"]
["AETNA MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["AETNA MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["AETNA MEDICARE MANAGED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["AETNA MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["AETNA MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["AETNA MEDICARE MANAGED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["AETNA MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["AETNA MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["AETNA MEDICARE MANAGED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["AETNA MEDICARE MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["AETNA MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["AETNA MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["AETNA MEDICARE MANAGED","80061 - CHG LIPID PANEL"]
["AETNA MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["AETNA MEDICARE MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["AETNA MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["AETNA MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["AETNA MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["AETNA MEDICARE MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["AETNA MEDICARE MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["AETNA MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["AETNA MEDICARE MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["AETNA MEDICARE MANAGED","85027 - CHG COMPLETE CBC"]
["AETNA MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["AETNA MEDICARE MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["AETNA MEDICARE MANAGED","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["AETNA MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["AETNA MEDICARE MANAGED","90715 - PR TDAP VACCINE >7 YO, IM"]
["AETNA MEDICARE MANAGED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["AETNA MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["AETNA MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["AETNA MEDICARE MANAGED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["AETNA MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["AETNA MEDICARE MANAGED","90853 - PR GROUP PSYCHOTHERAPY"]
["AETNA MEDICARE MANAGED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["AETNA MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["AETNA MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["AETNA MEDICARE MANAGED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["AETNA MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["AETNA MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["AETNA MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["AETNA MEDICARE MANAGED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["AETNA MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["AETNA MEDICARE MANAGED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["AETNA MEDICARE MANAGED","A9500 - PR TC99M SESTAMIBI"]
["AETNA MEDICARE MANAGED","A9513 - DELETED 2077"]
["AETNA MEDICARE MANAGED","A9517 - PR I131 IODIDE CAP, RX"]
["AETNA MEDICARE MANAGED","A9552 - PR F18 FDG"]
["AETNA MEDICARE MANAGED","A9555 - PR RB82 RUBIDIUM"]
["AETNA MEDICARE MANAGED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["AETNA MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["AETNA MEDICARE MANAGED","A9581 - PR GADOXETATE DISODIUM INJ"]
["AETNA MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["AETNA MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AETNA MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AETNA MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["AETNA MEDICARE MANAGED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["AETNA MEDICARE MANAGED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["AETNA MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS","19120 - PR EXCISE BREAST CYST"]
["BCBS","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["BCBS","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["BCBS","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["BCBS","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["BCBS","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["BCBS","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["BCBS","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["BCBS","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["BCBS","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["BCBS","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["BCBS","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["BCBS","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["BCBS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["BCBS","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["BCBS","70553 - CHG MRI BRAIN COMBO"]
["BCBS","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["BCBS","72148 - CHG MRI, LUMBAR SPINE"]
["BCBS","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["BCBS","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["BCBS","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["BCBS","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["BCBS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["BCBS","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["BCBS","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["BCBS","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["BCBS","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["BCBS","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["BCBS","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["BCBS","80055 - CHG OBSTETRIC PANEL"]
["BCBS","80061 - CHG LIPID PANEL"]
["BCBS","80069 - CHG RENAL FUNCTION PANEL"]
["BCBS","80076 - CHG HEPATIC FUNCTION PANEL"]
["BCBS","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["BCBS","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["BCBS","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["BCBS","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["BCBS","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["BCBS","84443 - CHG ASSAY THYROID STIM HORMONE"]
["BCBS","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["BCBS","85027 - CHG COMPLETE CBC"]
["BCBS","85610 - CHG PROTHROMBIN TIME"]
["BCBS","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["BCBS","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["BCBS","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["BCBS","90715 - PR TDAP VACCINE >7 YO, IM"]
["BCBS","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["BCBS","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["BCBS","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["BCBS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["BCBS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["BCBS","90853 - PR GROUP PSYCHOTHERAPY"]
["BCBS","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["BCBS","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["BCBS","97110 - PR THERAPEUTIC EXERCISES"]
["BCBS","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["BCBS","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["BCBS","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["BCBS","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["BCBS","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["BCBS","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["BCBS","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["BCBS","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["BCBS","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["BCBS","A9500 - PR TC99M SESTAMIBI"]
["BCBS","A9513 - DELETED 2077"]
["BCBS","A9517 - PR I131 IODIDE CAP, RX"]
["BCBS","A9552 - PR F18 FDG"]
["BCBS","A9555 - PR RB82 RUBIDIUM"]
["BCBS","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["BCBS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BCBS","A9581 - PR GADOXETATE DISODIUM INJ"]
["BCBS","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["BCBS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["BCBS","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["BCBS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BCBS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["BCBS MEDICARE MANAGED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["BCBS MEDICARE MANAGED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["BCBS MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["BCBS MEDICARE MANAGED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["BCBS MEDICARE MANAGED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["BCBS MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["BCBS MEDICARE MANAGED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["BCBS MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["BCBS MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["BCBS MEDICARE MANAGED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["BCBS MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["BCBS MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["BCBS MEDICARE MANAGED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["BCBS MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["BCBS MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["BCBS MEDICARE MANAGED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["BCBS MEDICARE MANAGED","72148 - CHG MRI, LUMBAR SPINE"]
["BCBS MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["BCBS MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["BCBS MEDICARE MANAGED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["BCBS MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["BCBS MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["BCBS MEDICARE MANAGED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["BCBS MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["BCBS MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["BCBS MEDICARE MANAGED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["BCBS MEDICARE MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["BCBS MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["BCBS MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["BCBS MEDICARE MANAGED","80061 - CHG LIPID PANEL"]
["BCBS MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["BCBS MEDICARE MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["BCBS MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["BCBS MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["BCBS MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["BCBS MEDICARE MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["BCBS MEDICARE MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["BCBS MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["BCBS MEDICARE MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["BCBS MEDICARE MANAGED","85027 - CHG COMPLETE CBC"]
["BCBS MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["BCBS MEDICARE MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["BCBS MEDICARE MANAGED","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["BCBS MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["BCBS MEDICARE MANAGED","90715 - PR TDAP VACCINE >7 YO, IM"]
["BCBS MEDICARE MANAGED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["BCBS MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["BCBS MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["BCBS MEDICARE MANAGED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["BCBS MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["BCBS MEDICARE MANAGED","90853 - PR GROUP PSYCHOTHERAPY"]
["BCBS MEDICARE MANAGED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["BCBS MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["BCBS MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["BCBS MEDICARE MANAGED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["BCBS MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["BCBS MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["BCBS MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["BCBS MEDICARE MANAGED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["BCBS MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["BCBS MEDICARE MANAGED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["BCBS MEDICARE MANAGED","A9500 - PR TC99M SESTAMIBI"]
["BCBS MEDICARE MANAGED","A9513 - DELETED 2077"]
["BCBS MEDICARE MANAGED","A9517 - PR I131 IODIDE CAP, RX"]
["BCBS MEDICARE MANAGED","A9552 - PR F18 FDG"]
["BCBS MEDICARE MANAGED","A9555 - PR RB82 RUBIDIUM"]
["BCBS MEDICARE MANAGED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["BCBS MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BCBS MEDICARE MANAGED","A9581 - PR GADOXETATE DISODIUM INJ"]
["BCBS MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["BCBS MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["BCBS MEDICARE MANAGED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["BCBS MEDICARE MANAGED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BCBS MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS OUT OF STATE","19120 - PR EXCISE BREAST CYST"]
["BCBS OUT OF STATE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["BCBS OUT OF STATE","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["BCBS OUT OF STATE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["BCBS OUT OF STATE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["BCBS OUT OF STATE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["BCBS OUT OF STATE","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["BCBS OUT OF STATE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["BCBS OUT OF STATE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["BCBS OUT OF STATE","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["BCBS OUT OF STATE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["BCBS OUT OF STATE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["BCBS OUT OF STATE","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["BCBS OUT OF STATE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["BCBS OUT OF STATE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["BCBS OUT OF STATE","70553 - CHG MRI BRAIN COMBO"]
["BCBS OUT OF STATE","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["BCBS OUT OF STATE","72148 - CHG MRI, LUMBAR SPINE"]
["BCBS OUT OF STATE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["BCBS OUT OF STATE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["BCBS OUT OF STATE","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["BCBS OUT OF STATE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["BCBS OUT OF STATE","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["BCBS OUT OF STATE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["BCBS OUT OF STATE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["BCBS OUT OF STATE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["BCBS OUT OF STATE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["BCBS OUT OF STATE","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["BCBS OUT OF STATE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["BCBS OUT OF STATE","80055 - CHG OBSTETRIC PANEL"]
["BCBS OUT OF STATE","80061 - CHG LIPID PANEL"]
["BCBS OUT OF STATE","80069 - CHG RENAL FUNCTION PANEL"]
["BCBS OUT OF STATE","80076 - CHG HEPATIC FUNCTION PANEL"]
["BCBS OUT OF STATE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["BCBS OUT OF STATE","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["BCBS OUT OF STATE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["BCBS OUT OF STATE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["BCBS OUT OF STATE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["BCBS OUT OF STATE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["BCBS OUT OF STATE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["BCBS OUT OF STATE","85027 - CHG COMPLETE CBC"]
["BCBS OUT OF STATE","85610 - CHG PROTHROMBIN TIME"]
["BCBS OUT OF STATE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["BCBS OUT OF STATE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["BCBS OUT OF STATE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["BCBS OUT OF STATE","90715 - PR TDAP VACCINE >7 YO, IM"]
["BCBS OUT OF STATE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["BCBS OUT OF STATE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["BCBS OUT OF STATE","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["BCBS OUT OF STATE","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["BCBS OUT OF STATE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["BCBS OUT OF STATE","90853 - PR GROUP PSYCHOTHERAPY"]
["BCBS OUT OF STATE","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["BCBS OUT OF STATE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["BCBS OUT OF STATE","97110 - PR THERAPEUTIC EXERCISES"]
["BCBS OUT OF STATE","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["BCBS OUT OF STATE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["BCBS OUT OF STATE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["BCBS OUT OF STATE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["BCBS OUT OF STATE","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["BCBS OUT OF STATE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["BCBS OUT OF STATE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["BCBS OUT OF STATE","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["BCBS OUT OF STATE","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["BCBS OUT OF STATE","A9500 - PR TC99M SESTAMIBI"]
["BCBS OUT OF STATE","A9513 - DELETED 2077"]
["BCBS OUT OF STATE","A9517 - PR I131 IODIDE CAP, RX"]
["BCBS OUT OF STATE","A9552 - PR F18 FDG"]
["BCBS OUT OF STATE","A9555 - PR RB82 RUBIDIUM"]
["BCBS OUT OF STATE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["BCBS OUT OF STATE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BCBS OUT OF STATE","A9581 - PR GADOXETATE DISODIUM INJ"]
["BCBS OUT OF STATE","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["BCBS OUT OF STATE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS OUT OF STATE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS OUT OF STATE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["BCBS OUT OF STATE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["BCBS OUT OF STATE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BCBS OUT OF STATE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CCA","19120 - PR EXCISE BREAST CYST"]
["CCA","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["CCA","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["CCA","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["CCA","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["CCA","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["CCA","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["CCA","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["CCA","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["CCA","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["CCA","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["CCA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["CCA","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["CCA","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["CCA","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["CCA","70553 - CHG MRI BRAIN COMBO"]
["CCA","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["CCA","72148 - CHG MRI, LUMBAR SPINE"]
["CCA","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["CCA","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["CCA","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["CCA","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["CCA","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["CCA","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["CCA","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["CCA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["CCA","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["CCA","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["CCA","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["CCA","80055 - CHG OBSTETRIC PANEL"]
["CCA","80061 - CHG LIPID PANEL"]
["CCA","80069 - CHG RENAL FUNCTION PANEL"]
["CCA","80076 - CHG HEPATIC FUNCTION PANEL"]
["CCA","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["CCA","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["CCA","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["CCA","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["CCA","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["CCA","84443 - CHG ASSAY THYROID STIM HORMONE"]
["CCA","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["CCA","85027 - CHG COMPLETE CBC"]
["CCA","85610 - CHG PROTHROMBIN TIME"]
["CCA","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["CCA","90715 - PR TDAP VACCINE >7 YO, IM"]
["CCA","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["CCA","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["CCA","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["CCA","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["CCA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["CCA","90853 - PR GROUP PSYCHOTHERAPY"]
["CCA","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["CCA","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["CCA","97110 - PR THERAPEUTIC EXERCISES"]
["CCA","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["CCA","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["CCA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["CCA","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["CCA","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["CCA","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["CCA","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["CCA","A9500 - PR TC99M SESTAMIBI"]
["CCA","A9513 - DELETED 2077"]
["CCA","A9517 - PR I131 IODIDE CAP, RX"]
["CCA","A9552 - PR F18 FDG"]
["CCA","A9555 - PR RB82 RUBIDIUM"]
["CCA","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["CCA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CCA","A9581 - PR GADOXETATE DISODIUM INJ"]
["CCA","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["CCA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CCA","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["CCA","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["CCA","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CCA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CCA MEDICARE PREFERRED","19120 - PR EXCISE BREAST CYST"]
["CCA MEDICARE PREFERRED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["CCA MEDICARE PREFERRED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["CCA MEDICARE PREFERRED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["CCA MEDICARE PREFERRED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["CCA MEDICARE PREFERRED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["CCA MEDICARE PREFERRED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["CCA MEDICARE PREFERRED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["CCA MEDICARE PREFERRED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["CCA MEDICARE PREFERRED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["CCA MEDICARE PREFERRED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["CCA MEDICARE PREFERRED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["CCA MEDICARE PREFERRED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["CCA MEDICARE PREFERRED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["CCA MEDICARE PREFERRED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["CCA MEDICARE PREFERRED","70553 - CHG MRI BRAIN COMBO"]
["CCA MEDICARE PREFERRED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["CCA MEDICARE PREFERRED","72148 - CHG MRI, LUMBAR SPINE"]
["CCA MEDICARE PREFERRED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["CCA MEDICARE PREFERRED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["CCA MEDICARE PREFERRED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["CCA MEDICARE PREFERRED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["CCA MEDICARE PREFERRED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["CCA MEDICARE PREFERRED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["CCA MEDICARE PREFERRED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["CCA MEDICARE PREFERRED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["CCA MEDICARE PREFERRED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["CCA MEDICARE PREFERRED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["CCA MEDICARE PREFERRED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["CCA MEDICARE PREFERRED","80055 - CHG OBSTETRIC PANEL"]
["CCA MEDICARE PREFERRED","80061 - CHG LIPID PANEL"]
["CCA MEDICARE PREFERRED","80069 - CHG RENAL FUNCTION PANEL"]
["CCA MEDICARE PREFERRED","80076 - CHG HEPATIC FUNCTION PANEL"]
["CCA MEDICARE PREFERRED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["CCA MEDICARE PREFERRED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["CCA MEDICARE PREFERRED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["CCA MEDICARE PREFERRED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["CCA MEDICARE PREFERRED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["CCA MEDICARE PREFERRED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["CCA MEDICARE PREFERRED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["CCA MEDICARE PREFERRED","85027 - CHG COMPLETE CBC"]
["CCA MEDICARE PREFERRED","85610 - CHG PROTHROMBIN TIME"]
["CCA MEDICARE PREFERRED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["CCA MEDICARE PREFERRED","90715 - PR TDAP VACCINE >7 YO, IM"]
["CCA MEDICARE PREFERRED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["CCA MEDICARE PREFERRED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["CCA MEDICARE PREFERRED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["CCA MEDICARE PREFERRED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["CCA MEDICARE PREFERRED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["CCA MEDICARE PREFERRED","90853 - PR GROUP PSYCHOTHERAPY"]
["CCA MEDICARE PREFERRED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["CCA MEDICARE PREFERRED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["CCA MEDICARE PREFERRED","97110 - PR THERAPEUTIC EXERCISES"]
["CCA MEDICARE PREFERRED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["CCA MEDICARE PREFERRED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["CCA MEDICARE PREFERRED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["CCA MEDICARE PREFERRED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["CCA MEDICARE PREFERRED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["CCA MEDICARE PREFERRED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["CCA MEDICARE PREFERRED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["CCA MEDICARE PREFERRED","A9500 - PR TC99M SESTAMIBI"]
["CCA MEDICARE PREFERRED","A9513 - DELETED 2077"]
["CCA MEDICARE PREFERRED","A9517 - PR I131 IODIDE CAP, RX"]
["CCA MEDICARE PREFERRED","A9552 - PR F18 FDG"]
["CCA MEDICARE PREFERRED","A9555 - PR RB82 RUBIDIUM"]
["CCA MEDICARE PREFERRED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["CCA MEDICARE PREFERRED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CCA MEDICARE PREFERRED","A9581 - PR GADOXETATE DISODIUM INJ"]
["CCA MEDICARE PREFERRED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["CCA MEDICARE PREFERRED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA MEDICARE PREFERRED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CCA MEDICARE PREFERRED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["CCA MEDICARE PREFERRED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["CCA MEDICARE PREFERRED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CCA MEDICARE PREFERRED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CIGNA","19120 - PR EXCISE BREAST CYST"]
["CIGNA","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["CIGNA","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["CIGNA","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["CIGNA","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["CIGNA","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["CIGNA","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["CIGNA","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["CIGNA","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["CIGNA","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["CIGNA","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["CIGNA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["CIGNA","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["CIGNA","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["CIGNA","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["CIGNA","70553 - CHG MRI BRAIN COMBO"]
["CIGNA","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["CIGNA","72148 - CHG MRI, LUMBAR SPINE"]
["CIGNA","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["CIGNA","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["CIGNA","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["CIGNA","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["CIGNA","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["CIGNA","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["CIGNA","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["CIGNA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["CIGNA","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["CIGNA","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["CIGNA","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["CIGNA","80055 - CHG OBSTETRIC PANEL"]
["CIGNA","80061 - CHG LIPID PANEL"]
["CIGNA","80069 - CHG RENAL FUNCTION PANEL"]
["CIGNA","80076 - CHG HEPATIC FUNCTION PANEL"]
["CIGNA","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["CIGNA","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["CIGNA","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["CIGNA","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["CIGNA","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["CIGNA","84443 - CHG ASSAY THYROID STIM HORMONE"]
["CIGNA","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["CIGNA","85027 - CHG COMPLETE CBC"]
["CIGNA","85610 - CHG PROTHROMBIN TIME"]
["CIGNA","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["CIGNA","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["CIGNA","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["CIGNA","90715 - PR TDAP VACCINE >7 YO, IM"]
["CIGNA","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["CIGNA","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["CIGNA","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["CIGNA","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["CIGNA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["CIGNA","90853 - PR GROUP PSYCHOTHERAPY"]
["CIGNA","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["CIGNA","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["CIGNA","97110 - PR THERAPEUTIC EXERCISES"]
["CIGNA","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["CIGNA","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["CIGNA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["CIGNA","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["CIGNA","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["CIGNA","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["CIGNA","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["CIGNA","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["CIGNA","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["CIGNA","A9500 - PR TC99M SESTAMIBI"]
["CIGNA","A9513 - DELETED 2077"]
["CIGNA","A9517 - PR I131 IODIDE CAP, RX"]
["CIGNA","A9552 - PR F18 FDG"]
["CIGNA","A9555 - PR RB82 RUBIDIUM"]
["CIGNA","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["CIGNA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CIGNA","A9581 - PR GADOXETATE DISODIUM INJ"]
["CIGNA","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["CIGNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CIGNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CIGNA","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["CIGNA","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["CIGNA","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CIGNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CORRECTIONS","19120 - PR EXCISE BREAST CYST"]
["CORRECTIONS","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["CORRECTIONS","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["CORRECTIONS","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["CORRECTIONS","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["CORRECTIONS","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["CORRECTIONS","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["CORRECTIONS","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["CORRECTIONS","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["CORRECTIONS","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["CORRECTIONS","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["CORRECTIONS","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["CORRECTIONS","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["CORRECTIONS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["CORRECTIONS","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["CORRECTIONS","70553 - CHG MRI BRAIN COMBO"]
["CORRECTIONS","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["CORRECTIONS","72148 - CHG MRI, LUMBAR SPINE"]
["CORRECTIONS","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["CORRECTIONS","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["CORRECTIONS","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["CORRECTIONS","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["CORRECTIONS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["CORRECTIONS","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["CORRECTIONS","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["CORRECTIONS","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["CORRECTIONS","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["CORRECTIONS","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["CORRECTIONS","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["CORRECTIONS","80055 - CHG OBSTETRIC PANEL"]
["CORRECTIONS","80061 - CHG LIPID PANEL"]
["CORRECTIONS","80069 - CHG RENAL FUNCTION PANEL"]
["CORRECTIONS","80076 - CHG HEPATIC FUNCTION PANEL"]
["CORRECTIONS","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["CORRECTIONS","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["CORRECTIONS","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["CORRECTIONS","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["CORRECTIONS","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["CORRECTIONS","84443 - CHG ASSAY THYROID STIM HORMONE"]
["CORRECTIONS","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["CORRECTIONS","85027 - CHG COMPLETE CBC"]
["CORRECTIONS","85610 - CHG PROTHROMBIN TIME"]
["CORRECTIONS","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["CORRECTIONS","90715 - PR TDAP VACCINE >7 YO, IM"]
["CORRECTIONS","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["CORRECTIONS","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["CORRECTIONS","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["CORRECTIONS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["CORRECTIONS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["CORRECTIONS","90853 - PR GROUP PSYCHOTHERAPY"]
["CORRECTIONS","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["CORRECTIONS","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["CORRECTIONS","97110 - PR THERAPEUTIC EXERCISES"]
["CORRECTIONS","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["CORRECTIONS","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["CORRECTIONS","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["CORRECTIONS","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["CORRECTIONS","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["CORRECTIONS","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["CORRECTIONS","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["CORRECTIONS","A9500 - PR TC99M SESTAMIBI"]
["CORRECTIONS","A9513 - DELETED 2077"]
["CORRECTIONS","A9517 - PR I131 IODIDE CAP, RX"]
["CORRECTIONS","A9552 - PR F18 FDG"]
["CORRECTIONS","A9555 - PR RB82 RUBIDIUM"]
["CORRECTIONS","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["CORRECTIONS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CORRECTIONS","A9581 - PR GADOXETATE DISODIUM INJ"]
["CORRECTIONS","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["CORRECTIONS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CORRECTIONS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CORRECTIONS","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["CORRECTIONS","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["CORRECTIONS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CORRECTIONS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON","19120 - PR EXCISE BREAST CYST"]
["FALLON","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["FALLON","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["FALLON","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["FALLON","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["FALLON","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["FALLON","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["FALLON","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["FALLON","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["FALLON","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["FALLON","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["FALLON","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["FALLON","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["FALLON","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["FALLON","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["FALLON","70553 - CHG MRI BRAIN COMBO"]
["FALLON","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["FALLON","72148 - CHG MRI, LUMBAR SPINE"]
["FALLON","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["FALLON","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["FALLON","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["FALLON","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["FALLON","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["FALLON","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["FALLON","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["FALLON","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["FALLON","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["FALLON","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON","80055 - CHG OBSTETRIC PANEL"]
["FALLON","80061 - CHG LIPID PANEL"]
["FALLON","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON","85027 - CHG COMPLETE CBC"]
["FALLON","85610 - CHG PROTHROMBIN TIME"]
["FALLON","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["FALLON","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["FALLON","90715 - PR TDAP VACCINE >7 YO, IM"]
["FALLON","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["FALLON","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["FALLON","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["FALLON","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["FALLON","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["FALLON","90853 - PR GROUP PSYCHOTHERAPY"]
["FALLON","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["FALLON","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["FALLON","97110 - PR THERAPEUTIC EXERCISES"]
["FALLON","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["FALLON","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["FALLON","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["FALLON","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["FALLON","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["FALLON","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["FALLON","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["FALLON","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["FALLON","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["FALLON","A9500 - PR TC99M SESTAMIBI"]
["FALLON","A9513 - DELETED 2077"]
["FALLON","A9517 - PR I131 IODIDE CAP, RX"]
["FALLON","A9552 - PR F18 FDG"]
["FALLON","A9555 - PR RB82 RUBIDIUM"]
["FALLON","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["FALLON","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["FALLON","A9581 - PR GADOXETATE DISODIUM INJ"]
["FALLON","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["FALLON","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["FALLON","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["FALLON","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["FALLON","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON HEALTHCRE ACO","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON HEALTHCRE ACO","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON HEALTHCRE ACO","80055 - CHG OBSTETRIC PANEL"]
["FALLON HEALTHCRE ACO","80061 - CHG LIPID PANEL"]
["FALLON HEALTHCRE ACO","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON HEALTHCRE ACO","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON HEALTHCRE ACO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON HEALTHCRE ACO","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON HEALTHCRE ACO","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON HEALTHCRE ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON HEALTHCRE ACO","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON HEALTHCRE ACO","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON HEALTHCRE ACO","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON HEALTHCRE ACO","85027 - CHG COMPLETE CBC"]
["FALLON HEALTHCRE ACO","85610 - CHG PROTHROMBIN TIME"]
["FALLON HEALTHCRE ACO","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON MEDICAID MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON MEDICAID MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON MEDICAID MANAGED","80055 - CHG OBSTETRIC PANEL"]
["FALLON MEDICAID MANAGED","80061 - CHG LIPID PANEL"]
["FALLON MEDICAID MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON MEDICAID MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON MEDICAID MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON MEDICAID MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON MEDICAID MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON MEDICAID MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON MEDICAID MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON MEDICAID MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON MEDICAID MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON MEDICAID MANAGED","85027 - CHG COMPLETE CBC"]
["FALLON MEDICAID MANAGED","85610 - CHG PROTHROMBIN TIME"]
["FALLON MEDICAID MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["FALLON MEDICARE MANAGED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["FALLON MEDICARE MANAGED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["FALLON MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["FALLON MEDICARE MANAGED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["FALLON MEDICARE MANAGED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["FALLON MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["FALLON MEDICARE MANAGED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["FALLON MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["FALLON MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["FALLON MEDICARE MANAGED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["FALLON MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["FALLON MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["FALLON MEDICARE MANAGED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["FALLON MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["FALLON MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["FALLON MEDICARE MANAGED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["FALLON MEDICARE MANAGED","72148 - CHG MRI, LUMBAR SPINE"]
["FALLON MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["FALLON MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["FALLON MEDICARE MANAGED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["FALLON MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["FALLON MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["FALLON MEDICARE MANAGED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["FALLON MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["FALLON MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["FALLON MEDICARE MANAGED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["FALLON MEDICARE MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["FALLON MEDICARE MANAGED","80061 - CHG LIPID PANEL"]
["FALLON MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON MEDICARE MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON MEDICARE MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON MEDICARE MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON MEDICARE MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON MEDICARE MANAGED","85027 - CHG COMPLETE CBC"]
["FALLON MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["FALLON MEDICARE MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON MEDICARE MANAGED","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["FALLON MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["FALLON MEDICARE MANAGED","90715 - PR TDAP VACCINE >7 YO, IM"]
["FALLON MEDICARE MANAGED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["FALLON MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["FALLON MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["FALLON MEDICARE MANAGED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["FALLON MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["FALLON MEDICARE MANAGED","90853 - PR GROUP PSYCHOTHERAPY"]
["FALLON MEDICARE MANAGED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["FALLON MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["FALLON MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["FALLON MEDICARE MANAGED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["FALLON MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["FALLON MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["FALLON MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["FALLON MEDICARE MANAGED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["FALLON MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["FALLON MEDICARE MANAGED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["FALLON MEDICARE MANAGED","A9500 - PR TC99M SESTAMIBI"]
["FALLON MEDICARE MANAGED","A9513 - DELETED 2077"]
["FALLON MEDICARE MANAGED","A9517 - PR I131 IODIDE CAP, RX"]
["FALLON MEDICARE MANAGED","A9552 - PR F18 FDG"]
["FALLON MEDICARE MANAGED","A9555 - PR RB82 RUBIDIUM"]
["FALLON MEDICARE MANAGED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["FALLON MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["FALLON MEDICARE MANAGED","A9581 - PR GADOXETATE DISODIUM INJ"]
["FALLON MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["FALLON MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["FALLON MEDICARE MANAGED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["FALLON MEDICARE MANAGED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["FALLON MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON SCO","19120 - PR EXCISE BREAST CYST"]
["FALLON SCO","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["FALLON SCO","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["FALLON SCO","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["FALLON SCO","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["FALLON SCO","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["FALLON SCO","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["FALLON SCO","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["FALLON SCO","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["FALLON SCO","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["FALLON SCO","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["FALLON SCO","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["FALLON SCO","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["FALLON SCO","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["FALLON SCO","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["FALLON SCO","70553 - CHG MRI BRAIN COMBO"]
["FALLON SCO","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["FALLON SCO","72148 - CHG MRI, LUMBAR SPINE"]
["FALLON SCO","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["FALLON SCO","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["FALLON SCO","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["FALLON SCO","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["FALLON SCO","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["FALLON SCO","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["FALLON SCO","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["FALLON SCO","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["FALLON SCO","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["FALLON SCO","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON SCO","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON SCO","80055 - CHG OBSTETRIC PANEL"]
["FALLON SCO","80061 - CHG LIPID PANEL"]
["FALLON SCO","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON SCO","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON SCO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON SCO","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON SCO","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON SCO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON SCO","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON SCO","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON SCO","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON SCO","90715 - PR TDAP VACCINE >7 YO, IM"]
["FALLON SCO","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["FALLON SCO","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["FALLON SCO","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["FALLON SCO","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["FALLON SCO","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["FALLON SCO","A9513 - DELETED 2077"]
["FALLON SCO","A9555 - PR RB82 RUBIDIUM"]
["FALLON SCO","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON SCO","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["HARVARD PILGRIM HEALTH CARE","19120 - PR EXCISE BREAST CYST"]
["HARVARD PILGRIM HEALTH CARE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["HARVARD PILGRIM HEALTH CARE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["HARVARD PILGRIM HEALTH CARE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["HARVARD PILGRIM HEALTH CARE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["HARVARD PILGRIM HEALTH CARE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["HARVARD PILGRIM HEALTH CARE","72148 - CHG MRI, LUMBAR SPINE"]
["HARVARD PILGRIM HEALTH CARE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["HARVARD PILGRIM HEALTH CARE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["HARVARD PILGRIM HEALTH CARE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["HARVARD PILGRIM HEALTH CARE","80055 - CHG OBSTETRIC PANEL"]
["HARVARD PILGRIM HEALTH CARE","80076 - CHG HEPATIC FUNCTION PANEL"]
["HARVARD PILGRIM HEALTH CARE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["HARVARD PILGRIM HEALTH CARE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["HARVARD PILGRIM HEALTH CARE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["HARVARD PILGRIM HEALTH CARE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["HARVARD PILGRIM HEALTH CARE","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["HARVARD PILGRIM HEALTH CARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["HARVARD PILGRIM HEALTH CARE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["HARVARD PILGRIM HEALTH CARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["HARVARD PILGRIM HEALTH CARE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["HARVARD PILGRIM HEALTH CARE","A9500 - PR TC99M SESTAMIBI"]
["HARVARD PILGRIM HEALTH CARE","A9552 - PR F18 FDG"]
["HARVARD PILGRIM HEALTH CARE","A9581 - PR GADOXETATE DISODIUM INJ"]
["HARVARD PILGRIM HEALTH CARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HARVARD PILGRIM HEALTH CARE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HEALTH PLANS INC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["HEALTH PLANS INC","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["HEALTH PLANS INC","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["HEALTH PLANS INC","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["HEALTH PLANS INC","72148 - CHG MRI, LUMBAR SPINE"]
["HEALTH PLANS INC","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["HEALTH PLANS INC","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["HEALTH PLANS INC","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["HEALTH PLANS INC","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["HEALTH PLANS INC","80069 - CHG RENAL FUNCTION PANEL"]
["HEALTH PLANS INC","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["HEALTH PLANS INC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["HEALTH PLANS INC","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["HEALTH PLANS INC","90715 - PR TDAP VACCINE >7 YO, IM"]
["HEALTH PLANS INC","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["HEALTH PLANS INC","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["HEALTH PLANS INC","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["HEALTH PLANS INC","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["HEALTH PLANS INC","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["HEALTH PLANS INC","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["HEALTH PLANS INC","A9517 - PR I131 IODIDE CAP, RX"]
["HEALTH PLANS INC","A9555 - PR RB82 RUBIDIUM"]
["HEALTH PLANS INC","A9581 - PR GADOXETATE DISODIUM INJ"]
["HEALTH PLANS INC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HEALTH PLANS INC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HLTH NEW ENGLAND ACO","80055 - CHG OBSTETRIC PANEL"]
["HLTH NEW ENGLAND ACO","80076 - CHG HEPATIC FUNCTION PANEL"]
["HLTH NEW ENGLAND ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["HLTH NEW ENGLAND ACO","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["HLTH NEW ENGLAND ACO","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["HPHC MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["HPHC MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["HPHC MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["HPHC MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["HPHC MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["HPHC MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["HPHC MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["HPHC MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["HPHC MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["HPHC MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["HPHC MEDICARE MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["HPHC MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["HPHC MEDICARE MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["HPHC MEDICARE MANAGED","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HPHC MEDICARE MANAGED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["HPHC MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["HPHC MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["HPHC MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["HPHC MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["HPHC MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["HPHC MEDICARE MANAGED","A9513 - DELETED 2077"]
["HPHC MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HPHC MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HPHC MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HPHC MEDICARE MANAGED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["HSN","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["HSN","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["HSN","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["HSN","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["HSN","70553 - CHG MRI BRAIN COMBO"]
["HSN","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["HSN","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["HSN","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["HSN","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["HSN","80061 - CHG LIPID PANEL"]
["HSN","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["HSN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["HSN","85027 - CHG COMPLETE CBC"]
["HSN","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HSN","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HSN","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["HSN","90853 - PR GROUP PSYCHOTHERAPY"]
["HSN","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["HSN","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["HSN","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["HSN","A9513 - DELETED 2077"]
["HSN","A9555 - PR RB82 RUBIDIUM"]
["HSN","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["HSN","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["HSN","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["HSN BAD DEBT","19120 - PR EXCISE BREAST CYST"]
["HSN BAD DEBT","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["HSN BAD DEBT","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["HSN BAD DEBT","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["HSN BAD DEBT","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["HSN BAD DEBT","70553 - CHG MRI BRAIN COMBO"]
["HSN BAD DEBT","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["HSN BAD DEBT","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["HSN BAD DEBT","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["HSN BAD DEBT","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["HSN BAD DEBT","80076 - CHG HEPATIC FUNCTION PANEL"]
["HSN BAD DEBT","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["HSN BAD DEBT","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["HSN BAD DEBT","85027 - CHG COMPLETE CBC"]
["HSN BAD DEBT","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HSN BAD DEBT","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["HSN BAD DEBT","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["HSN BAD DEBT","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["HSN BAD DEBT","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["HSN BAD DEBT","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["HSN BAD DEBT","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["HSN BAD DEBT","A9500 - PR TC99M SESTAMIBI"]
["HSN BAD DEBT","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["HSN BAD DEBT","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["HSN BAD DEBT","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["HSN CONFIDENTIAL","19120 - PR EXCISE BREAST CYST"]
["HSN CONFIDENTIAL","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["HSN CONFIDENTIAL","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["HSN CONFIDENTIAL","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["HSN CONFIDENTIAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["HSN CONFIDENTIAL","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["HSN CONFIDENTIAL","72148 - CHG MRI, LUMBAR SPINE"]
["HSN CONFIDENTIAL","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["HSN CONFIDENTIAL","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["HSN CONFIDENTIAL","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["HSN CONFIDENTIAL","80069 - CHG RENAL FUNCTION PANEL"]
["HSN CONFIDENTIAL","80076 - CHG HEPATIC FUNCTION PANEL"]
["HSN CONFIDENTIAL","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["HSN CONFIDENTIAL","84443 - CHG ASSAY THYROID STIM HORMONE"]
["HSN CONFIDENTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["HSN CONFIDENTIAL","90715 - PR TDAP VACCINE >7 YO, IM"]
["HSN CONFIDENTIAL","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["HSN CONFIDENTIAL","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["HSN CONFIDENTIAL","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["HSN CONFIDENTIAL","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["HSN CONFIDENTIAL","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["HSN CONFIDENTIAL","A9500 - PR TC99M SESTAMIBI"]
["HSN CONFIDENTIAL","A9552 - PR F18 FDG"]
["HSN CONFIDENTIAL","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HSN CONFIDENTIAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN CONFIDENTIAL","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["HSN DENTAL","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["HSN DENTAL","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["HSN DENTAL","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["HSN DENTAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["HSN DENTAL","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["HSN DENTAL","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["HSN DENTAL","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["HSN DENTAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["HSN DENTAL","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["HSN DENTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["HSN DENTAL","80061 - CHG LIPID PANEL"]
["HSN DENTAL","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["HSN DENTAL","84443 - CHG ASSAY THYROID STIM HORMONE"]
["HSN DENTAL","85610 - CHG PROTHROMBIN TIME"]
["HSN DENTAL","90715 - PR TDAP VACCINE >7 YO, IM"]
["HSN DENTAL","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["HSN DENTAL","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["HSN DENTAL","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["HSN DENTAL","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["HSN DENTAL","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["HSN DENTAL","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["HSN DENTAL","A9500 - PR TC99M SESTAMIBI"]
["HSN DENTAL","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HSN DENTAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN DENTAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN DENTAL","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["HSN PARTIAL","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["HSN PARTIAL","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["HSN PARTIAL","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["HSN PARTIAL","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["HSN PARTIAL","70553 - CHG MRI BRAIN COMBO"]
["HSN PARTIAL","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["HSN PARTIAL","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["HSN PARTIAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["HSN PARTIAL","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["HSN PARTIAL","80061 - CHG LIPID PANEL"]
["HSN PARTIAL","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["HSN PARTIAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["HSN PARTIAL","85027 - CHG COMPLETE CBC"]
["HSN PARTIAL","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HSN PARTIAL","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HSN PARTIAL","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["HSN PARTIAL","90853 - PR GROUP PSYCHOTHERAPY"]
["HSN PARTIAL","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["HSN PARTIAL","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["HSN PARTIAL","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["HSN PARTIAL","A9513 - DELETED 2077"]
["HSN PARTIAL","A9555 - PR RB82 RUBIDIUM"]
["HSN PARTIAL","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["HSN PARTIAL","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["HSN PARTIAL","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["HUMANA MEDICARE","19120 - PR EXCISE BREAST CYST"]
["HUMANA MEDICARE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["HUMANA MEDICARE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["HUMANA MEDICARE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["HUMANA MEDICARE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["HUMANA MEDICARE","70553 - CHG MRI BRAIN COMBO"]
["HUMANA MEDICARE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["HUMANA MEDICARE","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["HUMANA MEDICARE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["HUMANA MEDICARE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["HUMANA MEDICARE","80076 - CHG HEPATIC FUNCTION PANEL"]
["HUMANA MEDICARE","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["HUMANA MEDICARE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["HUMANA MEDICARE","85027 - CHG COMPLETE CBC"]
["HUMANA MEDICARE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HUMANA MEDICARE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["HUMANA MEDICARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["HUMANA MEDICARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["HUMANA MEDICARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["HUMANA MEDICARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["HUMANA MEDICARE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["HUMANA MEDICARE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["HUMANA MEDICARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HUMANA MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HUMANA MEDICARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","80076 - CHG HEPATIC FUNCTION PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","72148 - CHG MRI, LUMBAR SPINE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","80069 - CHG RENAL FUNCTION PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9513 - DELETED 2077"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9555 - PR RB82 RUBIDIUM"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9581 - PR GADOXETATE DISODIUM INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","80055 - CHG OBSTETRIC PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","85027 - CHG COMPLETE CBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","70553 - CHG MRI BRAIN COMBO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","80055 - CHG OBSTETRIC PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","80076 - CHG HEPATIC FUNCTION PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","85027 - CHG COMPLETE CBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","97110 - PR THERAPEUTIC EXERCISES"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","A9500 - PR TC99M SESTAMIBI"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","A9513 - DELETED 2077"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["MEDICAID","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["MEDICAID","80061 - CHG LIPID PANEL"]
["MEDICAID","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["MEDICAID","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["MEDICAID","85027 - CHG COMPLETE CBC"]
["MEDICAID","85610 - CHG PROTHROMBIN TIME"]
["MEDICAID ACO","80061 - CHG LIPID PANEL"]
["MEDICAID ACO","80076 - CHG HEPATIC FUNCTION PANEL"]
["MEDICAID ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MEDICAID ACO","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["MEDICAID LIMITED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["MEDICAID LIMITED","80061 - CHG LIPID PANEL"]
["MEDICAID LIMITED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["MEDICAID LIMITED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["MEDICAID LIMITED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["MEDICAID LIMITED","85027 - CHG COMPLETE CBC"]
["MEDICAID MANAGED CARE","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["MEDICAID MANAGED CARE","80076 - CHG HEPATIC FUNCTION PANEL"]
["MEDICAID MANAGED CARE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MEDICAID MANAGED CARE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["MEDICAID MANAGED CARE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["MEDICARE","19120 - PR EXCISE BREAST CYST"]
["MEDICARE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["MEDICARE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["MEDICARE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["MEDICARE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["MEDICARE","72148 - CHG MRI, LUMBAR SPINE"]
["MEDICARE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["MEDICARE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["MEDICARE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["MEDICARE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["MEDICARE","80076 - CHG HEPATIC FUNCTION PANEL"]
["MEDICARE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["MEDICARE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["MEDICARE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["MEDICARE","90715 - PR TDAP VACCINE >7 YO, IM"]
["MEDICARE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["MEDICARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["MEDICARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["MEDICARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["MEDICARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["MEDICARE","A9513 - DELETED 2077"]
["MEDICARE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["MEDICARE","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["MEDICARE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["NEIGHBORHOOD PACE","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["NEIGHBORHOOD PACE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["NEIGHBORHOOD PACE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["NEIGHBORHOOD PACE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["NEIGHBORHOOD PACE","70553 - CHG MRI BRAIN COMBO"]
["NEIGHBORHOOD PACE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["NEIGHBORHOOD PACE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["NEIGHBORHOOD PACE","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["NEIGHBORHOOD PACE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["NEIGHBORHOOD PACE","80055 - CHG OBSTETRIC PANEL"]
["NEIGHBORHOOD PACE","80069 - CHG RENAL FUNCTION PANEL"]
["NEIGHBORHOOD PACE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["NEIGHBORHOOD PACE","85027 - CHG COMPLETE CBC"]
["NEIGHBORHOOD PACE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["NEIGHBORHOOD PACE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["NEIGHBORHOOD PACE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["NEIGHBORHOOD PACE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["NEIGHBORHOOD PACE","97110 - PR THERAPEUTIC EXERCISES"]
["NEIGHBORHOOD PACE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["NEIGHBORHOOD PACE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["NEIGHBORHOOD PACE","A9517 - PR I131 IODIDE CAP, RX"]
["NEIGHBORHOOD PACE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["NEIGHBORHOOD PACE","A9581 - PR GADOXETATE DISODIUM INJ"]
["NEIGHBORHOOD PACE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["NEIGHBORHOOD PACE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["OXFORD HEALTH","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["OXFORD HEALTH","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["OXFORD HEALTH","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["OXFORD HEALTH","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["OXFORD HEALTH","70553 - CHG MRI BRAIN COMBO"]
["OXFORD HEALTH","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["OXFORD HEALTH","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["OXFORD HEALTH","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["OXFORD HEALTH","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["OXFORD HEALTH","80061 - CHG LIPID PANEL"]
["OXFORD HEALTH","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["OXFORD HEALTH","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["OXFORD HEALTH","85027 - CHG COMPLETE CBC"]
["OXFORD HEALTH","85610 - CHG PROTHROMBIN TIME"]
["OXFORD HEALTH","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["OXFORD HEALTH","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["OXFORD HEALTH","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["OXFORD HEALTH","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["OXFORD HEALTH","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["OXFORD HEALTH","A9500 - PR TC99M SESTAMIBI"]
["OXFORD HEALTH","A9513 - DELETED 2077"]
["OXFORD HEALTH","A9555 - PR RB82 RUBIDIUM"]
["OXFORD HEALTH","A9581 - PR GADOXETATE DISODIUM INJ"]
["OXFORD HEALTH","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["OXFORD HEALTH","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["SENIOR WHOLE HEALTH","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["SENIOR WHOLE HEALTH","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["SENIOR WHOLE HEALTH","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["SENIOR WHOLE HEALTH","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["SENIOR WHOLE HEALTH","72148 - CHG MRI, LUMBAR SPINE"]
["SENIOR WHOLE HEALTH","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["SENIOR WHOLE HEALTH","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["SENIOR WHOLE HEALTH","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["SENIOR WHOLE HEALTH","80069 - CHG RENAL FUNCTION PANEL"]
["SENIOR WHOLE HEALTH","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["SENIOR WHOLE HEALTH","84443 - CHG ASSAY THYROID STIM HORMONE"]
["SENIOR WHOLE HEALTH","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["SENIOR WHOLE HEALTH","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["SENIOR WHOLE HEALTH","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["SENIOR WHOLE HEALTH","90853 - PR GROUP PSYCHOTHERAPY"]
["SENIOR WHOLE HEALTH","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["SENIOR WHOLE HEALTH","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["SENIOR WHOLE HEALTH","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["SENIOR WHOLE HEALTH","A9500 - PR TC99M SESTAMIBI"]
["SENIOR WHOLE HEALTH","A9552 - PR F18 FDG"]
["SENIOR WHOLE HEALTH","A9581 - PR GADOXETATE DISODIUM INJ"]
["SENIOR WHOLE HEALTH","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["SENIOR WHOLE HEALTH","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TRICARE EAST","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["TRICARE EAST","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["TRICARE EAST","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["TRICARE EAST","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["TRICARE EAST","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["TRICARE EAST","72148 - CHG MRI, LUMBAR SPINE"]
["TRICARE EAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["TRICARE EAST","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["TRICARE EAST","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["TRICARE EAST","80069 - CHG RENAL FUNCTION PANEL"]
["TRICARE EAST","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["TRICARE EAST","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["TRICARE EAST","84443 - CHG ASSAY THYROID STIM HORMONE"]
["TRICARE EAST","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["TRICARE EAST","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["TRICARE EAST","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["TRICARE EAST","97110 - PR THERAPEUTIC EXERCISES"]
["TRICARE EAST","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["TRICARE EAST","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["TRICARE EAST","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["TRICARE EAST","A9513 - DELETED 2077"]
["TRICARE EAST","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["TRICARE EAST","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["TRICARE EAST","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["TRICARE FOR LIFE","19120 - PR EXCISE BREAST CYST"]
["TRICARE FOR LIFE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["TRICARE FOR LIFE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["TRICARE FOR LIFE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["TRICARE FOR LIFE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["TRICARE FOR LIFE","70553 - CHG MRI BRAIN COMBO"]
["TRICARE FOR LIFE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["TRICARE FOR LIFE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["TRICARE FOR LIFE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["TRICARE FOR LIFE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["TRICARE FOR LIFE","80055 - CHG OBSTETRIC PANEL"]
["TRICARE FOR LIFE","80076 - CHG HEPATIC FUNCTION PANEL"]
["TRICARE FOR LIFE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["TRICARE FOR LIFE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["TRICARE FOR LIFE","90715 - PR TDAP VACCINE >7 YO, IM"]
["TRICARE FOR LIFE","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["TRICARE FOR LIFE","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["TRICARE FOR LIFE","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["TRICARE FOR LIFE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["TRICARE FOR LIFE","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["TRICARE FOR LIFE","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["TRICARE FOR LIFE","A9517 - PR I131 IODIDE CAP, RX"]
["TRICARE FOR LIFE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["TRICARE FOR LIFE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TRICARE FOR LIFE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["TUFTS","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["TUFTS","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["TUFTS","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["TUFTS","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["TUFTS","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["TUFTS","70553 - CHG MRI BRAIN COMBO"]
["TUFTS","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["TUFTS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["TUFTS","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["TUFTS","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["TUFTS","80061 - CHG LIPID PANEL"]
["TUFTS","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["TUFTS","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["TUFTS","85027 - CHG COMPLETE CBC"]
["TUFTS","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["TUFTS","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["TUFTS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["TUFTS","90853 - PR GROUP PSYCHOTHERAPY"]
["TUFTS","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["TUFTS","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["TUFTS","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["TUFTS","A9513 - DELETED 2077"]
["TUFTS","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["TUFTS","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["TUFTS","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["TUFTS CONNCARE/QHP","19120 - PR EXCISE BREAST CYST"]
["TUFTS CONNCARE/QHP","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["TUFTS CONNCARE/QHP","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["TUFTS CONNCARE/QHP","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["TUFTS CONNCARE/QHP","70553 - CHG MRI BRAIN COMBO"]
["TUFTS CONNCARE/QHP","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["TUFTS CONNCARE/QHP","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["TUFTS CONNCARE/QHP","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["TUFTS CONNCARE/QHP","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["TUFTS CONNCARE/QHP","80055 - CHG OBSTETRIC PANEL"]
["TUFTS CONNCARE/QHP","80076 - CHG HEPATIC FUNCTION PANEL"]
["TUFTS CONNCARE/QHP","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["TUFTS CONNCARE/QHP","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["TUFTS CONNCARE/QHP","85027 - CHG COMPLETE CBC"]
["TUFTS CONNCARE/QHP","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["TUFTS CONNCARE/QHP","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["TUFTS CONNCARE/QHP","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["TUFTS CONNCARE/QHP","97110 - PR THERAPEUTIC EXERCISES"]
["TUFTS CONNCARE/QHP","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["TUFTS CONNCARE/QHP","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["TUFTS CONNCARE/QHP","A9500 - PR TC99M SESTAMIBI"]
["TUFTS CONNCARE/QHP","A9552 - PR F18 FDG"]
["TUFTS CONNCARE/QHP","A9555 - PR RB82 RUBIDIUM"]
["TUFTS CONNCARE/QHP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS CONNCARE/QHP","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["TUFTS MEDICARE","19120 - PR EXCISE BREAST CYST"]
["TUFTS MEDICARE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["TUFTS MEDICARE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["TUFTS MEDICARE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["TUFTS MEDICARE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["TUFTS MEDICARE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["TUFTS MEDICARE","72148 - CHG MRI, LUMBAR SPINE"]
["TUFTS MEDICARE","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["TUFTS MEDICARE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["TUFTS MEDICARE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["TUFTS MEDICARE","80076 - CHG HEPATIC FUNCTION PANEL"]
["TUFTS MEDICARE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["TUFTS MEDICARE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["TUFTS MEDICARE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["TUFTS MEDICARE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["TUFTS MEDICARE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["TUFTS MEDICARE","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["TUFTS MEDICARE","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["TUFTS MEDICARE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["TUFTS MEDICARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["TUFTS MEDICARE","A9513 - DELETED 2077"]
["TUFTS MEDICARE","A9517 - PR I131 IODIDE CAP, RX"]
["TUFTS MEDICARE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS MEDICARE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["TUFTS MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["TUFTS MEDICARE MANAGED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["TUFTS MEDICARE MANAGED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["TUFTS MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["TUFTS MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["TUFTS MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["TUFTS MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["TUFTS MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["TUFTS MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["TUFTS MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["TUFTS MEDICARE MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["TUFTS MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["TUFTS MEDICARE MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["TUFTS MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["TUFTS MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["TUFTS MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["TUFTS MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["TUFTS MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["TUFTS MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["TUFTS MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["TUFTS MEDICARE MANAGED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["TUFTS MEDICARE MANAGED","A9517 - PR I131 IODIDE CAP, RX"]
["TUFTS MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["TUFTS MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["TUFTS MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS TOGETHER ACO","80055 - CHG OBSTETRIC PANEL"]
["TUFTS TOGETHER ACO","80076 - CHG HEPATIC FUNCTION PANEL"]
["TUFTS TOGETHER ACO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["TUFTS TOGETHER ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["TUFTS TOGETHER ACO","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["TUFTS TOGETHER MCO","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["TUFTS TOGETHER MCO","80061 - CHG LIPID PANEL"]
["TUFTS TOGETHER MCO","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["TUFTS TOGETHER MCO","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["TUFTS TOGETHER MCO","85610 - CHG PROTHROMBIN TIME"]
["TUFTS TOGETHER MCO","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["UBH HPHC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["UBH HPHC","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["UBH HPHC","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["UBH HPHC","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["UBH HPHC","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["UBH HPHC","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["UBH HPHC","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["UBH HPHC","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["UBH HPHC","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["UBH HPHC","80069 - CHG RENAL FUNCTION PANEL"]
["UBH HPHC","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["UBH HPHC","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["UBH HPHC","85610 - CHG PROTHROMBIN TIME"]
["UBH HPHC","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["UBH HPHC","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["UBH HPHC","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["UBH HPHC","90853 - PR GROUP PSYCHOTHERAPY"]
["UBH HPHC","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["UBH HPHC","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["UBH HPHC","A9500 - PR TC99M SESTAMIBI"]
["UBH HPHC","A9555 - PR RB82 RUBIDIUM"]
["UBH HPHC","A9581 - PR GADOXETATE DISODIUM INJ"]
["UBH HPHC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UBH HPHC","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["UBH HPHC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNICARE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["UNICARE","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["UNICARE","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["UNICARE","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["UNICARE","72148 - CHG MRI, LUMBAR SPINE"]
["UNICARE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["UNICARE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["UNICARE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["UNICARE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["UNICARE","80069 - CHG RENAL FUNCTION PANEL"]
["UNICARE","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["UNICARE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["UNICARE","85610 - CHG PROTHROMBIN TIME"]
["UNICARE","90715 - PR TDAP VACCINE >7 YO, IM"]
["UNICARE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["UNICARE","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["UNICARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["UNICARE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["UNICARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["UNICARE","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["UNICARE","A9517 - PR I131 IODIDE CAP, RX"]
["UNICARE","A9552 - PR F18 FDG"]
["UNICARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UNICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["UNITED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["UNITED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["UNITED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["UNITED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["UNITED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["UNITED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["UNITED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["UNITED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["UNITED","80069 - CHG RENAL FUNCTION PANEL"]
["UNITED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["UNITED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["UNITED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["UNITED","85610 - CHG PROTHROMBIN TIME"]
["UNITED","90715 - PR TDAP VACCINE >7 YO, IM"]
["UNITED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["UNITED","90853 - PR GROUP PSYCHOTHERAPY"]
["UNITED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["UNITED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["UNITED","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["UNITED","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["UNITED","A9517 - PR I131 IODIDE CAP, RX"]
["UNITED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UNITED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["UNITED COMMUNITY PLAN","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["UNITED COMMUNITY PLAN","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["UNITED COMMUNITY PLAN","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["UNITED COMMUNITY PLAN","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["UNITED COMMUNITY PLAN","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["UNITED COMMUNITY PLAN","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["UNITED COMMUNITY PLAN","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["UNITED COMMUNITY PLAN","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["UNITED COMMUNITY PLAN","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["UNITED COMMUNITY PLAN","80055 - CHG OBSTETRIC PANEL"]
["UNITED COMMUNITY PLAN","80061 - CHG LIPID PANEL"]
["UNITED COMMUNITY PLAN","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["UNITED COMMUNITY PLAN","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["UNITED COMMUNITY PLAN","85027 - CHG COMPLETE CBC"]
["UNITED COMMUNITY PLAN","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["UNITED COMMUNITY PLAN","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["UNITED COMMUNITY PLAN","90853 - PR GROUP PSYCHOTHERAPY"]
["UNITED COMMUNITY PLAN","97110 - PR THERAPEUTIC EXERCISES"]
["UNITED COMMUNITY PLAN","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["UNITED COMMUNITY PLAN","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["UNITED COMMUNITY PLAN","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["UNITED COMMUNITY PLAN","A9552 - PR F18 FDG"]
["UNITED COMMUNITY PLAN","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UNITED COMMUNITY PLAN","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["UNITED COMMUNITY PLAN","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED MEDICARE MANAGED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["UNITED MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["UNITED MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["UNITED MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["UNITED MEDICARE MANAGED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["UNITED MEDICARE MANAGED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["UNITED MEDICARE MANAGED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["UNITED MEDICARE MANAGED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["UNITED MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["UNITED MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["UNITED MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["UNITED MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["UNITED MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["UNITED MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["UNITED MEDICARE MANAGED","90715 - PR TDAP VACCINE >7 YO, IM"]
["UNITED MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["UNITED MEDICARE MANAGED","90853 - PR GROUP PSYCHOTHERAPY"]
["UNITED MEDICARE MANAGED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["UNITED MEDICARE MANAGED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["UNITED MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["UNITED MEDICARE MANAGED","A9513 - DELETED 2077"]
["UNITED MEDICARE MANAGED","A9555 - PR RB82 RUBIDIUM"]
["UNITED MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["UNITED MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["UNITED MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UPHAMS CORNER ESP","19120 - PR EXCISE BREAST CYST"]
["UPHAMS CORNER ESP","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["UPHAMS CORNER ESP","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["UPHAMS CORNER ESP","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["UPHAMS CORNER ESP","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["UPHAMS CORNER ESP","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["UPHAMS CORNER ESP","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["UPHAMS CORNER ESP","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["UPHAMS CORNER ESP","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["UPHAMS CORNER ESP","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["UPHAMS CORNER ESP","80076 - CHG HEPATIC FUNCTION PANEL"]
["UPHAMS CORNER ESP","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["UPHAMS CORNER ESP","84443 - CHG ASSAY THYROID STIM HORMONE"]
["UPHAMS CORNER ESP","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["UPHAMS CORNER ESP","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["UPHAMS CORNER ESP","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["UPHAMS CORNER ESP","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["UPHAMS CORNER ESP","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["UPHAMS CORNER ESP","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["UPHAMS CORNER ESP","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["UPHAMS CORNER ESP","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["UPHAMS CORNER ESP","A9552 - PR F18 FDG"]
["UPHAMS CORNER ESP","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UPHAMS CORNER ESP","A9581 - PR GADOXETATE DISODIUM INJ"]
["UPHAMS CORNER ESP","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["UPHAMS CORNER ESP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLCARE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["WELLCARE","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["WELLCARE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["WELLCARE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["WELLCARE","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["WELLCARE","72148 - CHG MRI, LUMBAR SPINE"]
["WELLCARE","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["WELLCARE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["WELLCARE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["WELLCARE","80069 - CHG RENAL FUNCTION PANEL"]
["WELLCARE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["WELLCARE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["WELLCARE","85610 - CHG PROTHROMBIN TIME"]
["WELLCARE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["WELLCARE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["WELLCARE","90853 - PR GROUP PSYCHOTHERAPY"]
["WELLCARE","97110 - PR THERAPEUTIC EXERCISES"]
["WELLCARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["WELLCARE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["WELLCARE","A9552 - PR F18 FDG"]
["WELLCARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["WELLCARE","A9581 - PR GADOXETATE DISODIUM INJ"]
["WELLCARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLCARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLSENSE","80055 - CHG OBSTETRIC PANEL"]
["WELLSENSE","80076 - CHG HEPATIC FUNCTION PANEL"]
["WELLSENSE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["WELLSENSE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["WELLSENSE","85027 - CHG COMPLETE CBC"]
["WELLSENSE ALLI ACO","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["WELLSENSE ALLI ACO","80069 - CHG RENAL FUNCTION PANEL"]
["WELLSENSE ALLI ACO","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["WELLSENSE ALLI ACO","84443 - CHG ASSAY THYROID STIM HORMONE"]
["WELLSENSE ALLI ACO","85610 - CHG PROTHROMBIN TIME"]
["WELLSENSE ESSENTIAL MCO","80055 - CHG OBSTETRIC PANEL"]
["WELLSENSE ESSENTIAL MCO","80076 - CHG HEPATIC FUNCTION PANEL"]
["WELLSENSE ESSENTIAL MCO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["WELLSENSE ESSENTIAL MCO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["WELLSENSE ESSENTIAL MCO","85610 - CHG PROTHROMBIN TIME"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","70553 - CHG MRI BRAIN COMBO"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","80076 - CHG HEPATIC FUNCTION PANEL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","85027 - CHG COMPLETE CBC"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9500 - PR TC99M SESTAMIBI"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9513 - DELETED 2077"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9555 - PR RB82 RUBIDIUM"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9581 - PR GADOXETATE DISODIUM INJ"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLSENSE MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["WELLSENSE MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["WELLSENSE MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["WELLSENSE MEDICARE MANAGED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["WELLSENSE MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["WELLSENSE MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["WELLSENSE MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["WELLSENSE MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["WELLSENSE MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["WELLSENSE MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["WELLSENSE MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["WELLSENSE MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["WELLSENSE MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["WELLSENSE MEDICARE MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["WELLSENSE MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["WELLSENSE MEDICARE MANAGED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["WELLSENSE MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["WELLSENSE MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["WELLSENSE MEDICARE MANAGED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["WELLSENSE MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["WELLSENSE MEDICARE MANAGED","A9513 - DELETED 2077"]
["WELLSENSE MEDICARE MANAGED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["WELLSENSE MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["WELLSENSE MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["WELLSENSE MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WORKERS COMP","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["WORKERS COMP","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["WORKERS COMP","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["WORKERS COMP","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["WORKERS COMP","70553 - CHG MRI BRAIN COMBO"]
["WORKERS COMP","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["WORKERS COMP","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["WORKERS COMP","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["WORKERS COMP","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["WORKERS COMP","80076 - CHG HEPATIC FUNCTION PANEL"]
["WORKERS COMP","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["WORKERS COMP","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["WORKERS COMP","85027 - CHG COMPLETE CBC"]
["WORKERS COMP","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["WORKERS COMP","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["WORKERS COMP","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["WORKERS COMP","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["WORKERS COMP","97110 - PR THERAPEUTIC EXERCISES"]
["WORKERS COMP","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["WORKERS COMP","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["WORKERS COMP","A9513 - DELETED 2077"]
["WORKERS COMP","A9555 - PR RB82 RUBIDIUM"]
["WORKERS COMP","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["WORKERS COMP","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["WORKERS COMP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZAETNA","19120 - PR EXCISE BREAST CYST"]
["ZZZAETNA","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZAETNA","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["ZZZAETNA","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZAETNA","70553 - CHG MRI BRAIN COMBO"]
["ZZZAETNA","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["ZZZAETNA","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["ZZZAETNA","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["ZZZAETNA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZAETNA","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZAETNA","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZAETNA","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZAETNA","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZAETNA","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZAETNA","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["ZZZAETNA","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["ZZZAETNA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZAETNA","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["ZZZAETNA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZAETNA","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["ZZZAETNA","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["ZZZAETNA","A9552 - PR F18 FDG"]
["ZZZAETNA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ZZZAETNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZAETNA","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ZZZAETNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZBU EMPLOYEE WORK COMP","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZBU EMPLOYEE WORK COMP","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["ZZZBU EMPLOYEE WORK COMP","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["ZZZBU EMPLOYEE WORK COMP","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZBU EMPLOYEE WORK COMP","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["ZZZBU EMPLOYEE WORK COMP","72148 - CHG MRI, LUMBAR SPINE"]
["ZZZBU EMPLOYEE WORK COMP","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["ZZZBU EMPLOYEE WORK COMP","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["ZZZBU EMPLOYEE WORK COMP","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["ZZZBU EMPLOYEE WORK COMP","80069 - CHG RENAL FUNCTION PANEL"]
["ZZZBU EMPLOYEE WORK COMP","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["ZZZBU EMPLOYEE WORK COMP","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZBU EMPLOYEE WORK COMP","85610 - CHG PROTHROMBIN TIME"]
["ZZZBU EMPLOYEE WORK COMP","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZBU EMPLOYEE WORK COMP","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZBU EMPLOYEE WORK COMP","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["ZZZBU EMPLOYEE WORK COMP","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["ZZZBU EMPLOYEE WORK COMP","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["ZZZBU EMPLOYEE WORK COMP","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["ZZZBU EMPLOYEE WORK COMP","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["ZZZBU EMPLOYEE WORK COMP","A9517 - PR I131 IODIDE CAP, RX"]
["ZZZBU EMPLOYEE WORK COMP","A9552 - PR F18 FDG"]
["ZZZBU EMPLOYEE WORK COMP","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ZZZBU EMPLOYEE WORK COMP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZBU EMPLOYEE WORK COMP","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ZZZCCA ONECARE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["ZZZCCA ONECARE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["ZZZCCA ONECARE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["ZZZCCA ONECARE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["ZZZCCA ONECARE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["ZZZCCA ONECARE","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["ZZZCCA ONECARE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["ZZZCCA ONECARE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["ZZZCCA ONECARE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["ZZZCCA ONECARE","80061 - CHG LIPID PANEL"]
["ZZZCCA ONECARE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["ZZZCCA ONECARE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["ZZZCCA ONECARE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["ZZZCCA ONECARE","85027 - CHG COMPLETE CBC"]
["ZZZCCA ONECARE","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZCCA ONECARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZCCA ONECARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["ZZZCCA ONECARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZCCA ONECARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["ZZZCCA ONECARE","A9513 - DELETED 2077"]
["ZZZCCA ONECARE","A9517 - PR I131 IODIDE CAP, RX"]
["ZZZCCA ONECARE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["ZZZCCA ONECARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCCA ONECARE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["ZZZCIGNA","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["ZZZCIGNA","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["ZZZCIGNA","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["ZZZCIGNA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["ZZZCIGNA","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["ZZZCIGNA","70553 - CHG MRI BRAIN COMBO"]
["ZZZCIGNA","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["ZZZCIGNA","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["ZZZCIGNA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZCIGNA","80055 - CHG OBSTETRIC PANEL"]
["ZZZCIGNA","80061 - CHG LIPID PANEL"]
["ZZZCIGNA","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["ZZZCIGNA","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["ZZZCIGNA","85027 - CHG COMPLETE CBC"]
["ZZZCIGNA","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["ZZZCIGNA","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["ZZZCIGNA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZCIGNA","97110 - PR THERAPEUTIC EXERCISES"]
["ZZZCIGNA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZCIGNA","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["ZZZCIGNA","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["ZZZCIGNA","A9513 - DELETED 2077"]
["ZZZCIGNA","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["ZZZCIGNA","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["ZZZCIGNA","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["ZZZCITY OF BOSTON WORK COMP","19120 - PR EXCISE BREAST CYST"]
["ZZZCITY OF BOSTON WORK COMP","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZCITY OF BOSTON WORK COMP","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["ZZZCITY OF BOSTON WORK COMP","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["ZZZCITY OF BOSTON WORK COMP","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZCITY OF BOSTON WORK COMP","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZCITY OF BOSTON WORK COMP","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["ZZZCITY OF BOSTON WORK COMP","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["ZZZCITY OF BOSTON WORK COMP","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZCITY OF BOSTON WORK COMP","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZCITY OF BOSTON WORK COMP","80055 - CHG OBSTETRIC PANEL"]
["ZZZCITY OF BOSTON WORK COMP","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZCITY OF BOSTON WORK COMP","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZCITY OF BOSTON WORK COMP","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["ZZZCITY OF BOSTON WORK COMP","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZCITY OF BOSTON WORK COMP","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["ZZZCITY OF BOSTON WORK COMP","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZCITY OF BOSTON WORK COMP","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["ZZZCITY OF BOSTON WORK COMP","97110 - PR THERAPEUTIC EXERCISES"]
["ZZZCITY OF BOSTON WORK COMP","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZCITY OF BOSTON WORK COMP","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["ZZZCITY OF BOSTON WORK COMP","A9500 - PR TC99M SESTAMIBI"]
["ZZZCITY OF BOSTON WORK COMP","A9552 - PR F18 FDG"]
["ZZZCITY OF BOSTON WORK COMP","A9581 - PR GADOXETATE DISODIUM INJ"]
["ZZZCITY OF BOSTON WORK COMP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCITY OF BOSTON WORK COMP","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","19120 - PR EXCISE BREAST CYST"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","72148 - CHG MRI, LUMBAR SPINE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","80055 - CHG OBSTETRIC PANEL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9500 - PR TC99M SESTAMIBI"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9513 - DELETED 2077"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9517 - PR I131 IODIDE CAP, RX"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9552 - PR F18 FDG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9555 - PR RB82 RUBIDIUM"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9581 - PR GADOXETATE DISODIUM INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZHEALTH PLANS INC","19120 - PR EXCISE BREAST CYST"]
["ZZZHEALTH PLANS INC","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["ZZZHEALTH PLANS INC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["ZZZHEALTH PLANS INC","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZHEALTH PLANS INC","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["ZZZHEALTH PLANS INC","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["ZZZHEALTH PLANS INC","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["ZZZHEALTH PLANS INC","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["ZZZHEALTH PLANS INC","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["ZZZHEALTH PLANS INC","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["ZZZHEALTH PLANS INC","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZHEALTH PLANS INC","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["ZZZHEALTH PLANS INC","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["ZZZHEALTH PLANS INC","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZHEALTH PLANS INC","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["ZZZHEALTH PLANS INC","70553 - CHG MRI BRAIN COMBO"]
["ZZZHEALTH PLANS INC","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["ZZZHEALTH PLANS INC","72148 - CHG MRI, LUMBAR SPINE"]
["ZZZHEALTH PLANS INC","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["ZZZHEALTH PLANS INC","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["ZZZHEALTH PLANS INC","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["ZZZHEALTH PLANS INC","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["ZZZHEALTH PLANS INC","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["ZZZHEALTH PLANS INC","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["ZZZHEALTH PLANS INC","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["ZZZHEALTH PLANS INC","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZHEALTH PLANS INC","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["ZZZHEALTH PLANS INC","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["ZZZHEALTH PLANS INC","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZHEALTH PLANS INC","80055 - CHG OBSTETRIC PANEL"]
["ZZZHEALTH PLANS INC","80061 - CHG LIPID PANEL"]
["ZZZHEALTH PLANS INC","80069 - CHG RENAL FUNCTION PANEL"]
["ZZZHEALTH PLANS INC","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZHEALTH PLANS INC","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["ZZZHEALTH PLANS INC","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["ZZZHEALTH PLANS INC","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZHEALTH PLANS INC","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["ZZZHEALTH PLANS INC","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["ZZZHEALTH PLANS INC","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZHEALTH PLANS INC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["ZZZHEALTH PLANS INC","85027 - CHG COMPLETE CBC"]
["ZZZHEALTH PLANS INC","85610 - CHG PROTHROMBIN TIME"]
["ZZZHEALTH PLANS INC","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZHEALTH PLANS INC","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["ZZZHEALTH PLANS INC","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["ZZZHEALTH PLANS INC","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZHEALTH PLANS INC","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["ZZZHEALTH PLANS INC","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["ZZZHEALTH PLANS INC","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["ZZZHEALTH PLANS INC","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["ZZZHEALTH PLANS INC","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZHEALTH PLANS INC","90853 - PR GROUP PSYCHOTHERAPY"]
["ZZZHEALTH PLANS INC","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["ZZZHEALTH PLANS INC","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["ZZZHEALTH PLANS INC","97110 - PR THERAPEUTIC EXERCISES"]
["ZZZHEALTH PLANS INC","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["ZZZHEALTH PLANS INC","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["ZZZHEALTH PLANS INC","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZHEALTH PLANS INC","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["ZZZHEALTH PLANS INC","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["ZZZHEALTH PLANS INC","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["ZZZHEALTH PLANS INC","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["ZZZHEALTH PLANS INC","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["ZZZHEALTH PLANS INC","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["ZZZHEALTH PLANS INC","A9500 - PR TC99M SESTAMIBI"]
["ZZZHEALTH PLANS INC","A9513 - DELETED 2077"]
["ZZZHEALTH PLANS INC","A9517 - PR I131 IODIDE CAP, RX"]
["ZZZHEALTH PLANS INC","A9552 - PR F18 FDG"]
["ZZZHEALTH PLANS INC","A9555 - PR RB82 RUBIDIUM"]
["ZZZHEALTH PLANS INC","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["ZZZHEALTH PLANS INC","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ZZZHEALTH PLANS INC","A9581 - PR GADOXETATE DISODIUM INJ"]
["ZZZHEALTH PLANS INC","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["ZZZHEALTH PLANS INC","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZHEALTH PLANS INC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZHEALTH PLANS INC","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["ZZZHEALTH PLANS INC","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["ZZZHEALTH PLANS INC","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ZZZHEALTH PLANS INC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZRAILROAD MEDICARE","19120 - PR EXCISE BREAST CYST"]
["ZZZRAILROAD MEDICARE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["ZZZRAILROAD MEDICARE","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["ZZZRAILROAD MEDICARE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZRAILROAD MEDICARE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["ZZZRAILROAD MEDICARE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["ZZZRAILROAD MEDICARE","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["ZZZRAILROAD MEDICARE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["ZZZRAILROAD MEDICARE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["ZZZRAILROAD MEDICARE","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["ZZZRAILROAD MEDICARE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZRAILROAD MEDICARE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["ZZZRAILROAD MEDICARE","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["ZZZRAILROAD MEDICARE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZRAILROAD MEDICARE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["ZZZRAILROAD MEDICARE","70553 - CHG MRI BRAIN COMBO"]
["ZZZRAILROAD MEDICARE","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["ZZZRAILROAD MEDICARE","72148 - CHG MRI, LUMBAR SPINE"]
["ZZZRAILROAD MEDICARE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["ZZZRAILROAD MEDICARE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["ZZZRAILROAD MEDICARE","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["ZZZRAILROAD MEDICARE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["ZZZRAILROAD MEDICARE","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["ZZZRAILROAD MEDICARE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["ZZZRAILROAD MEDICARE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["ZZZRAILROAD MEDICARE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZRAILROAD MEDICARE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["ZZZRAILROAD MEDICARE","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["ZZZRAILROAD MEDICARE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZRAILROAD MEDICARE","80055 - CHG OBSTETRIC PANEL"]
["ZZZRAILROAD MEDICARE","80061 - CHG LIPID PANEL"]
["ZZZRAILROAD MEDICARE","80069 - CHG RENAL FUNCTION PANEL"]
["ZZZRAILROAD MEDICARE","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZRAILROAD MEDICARE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["ZZZRAILROAD MEDICARE","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["ZZZRAILROAD MEDICARE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZRAILROAD MEDICARE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["ZZZRAILROAD MEDICARE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["ZZZRAILROAD MEDICARE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZRAILROAD MEDICARE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["ZZZRAILROAD MEDICARE","85027 - CHG COMPLETE CBC"]
["ZZZRAILROAD MEDICARE","85610 - CHG PROTHROMBIN TIME"]
["ZZZRAILROAD MEDICARE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZRAILROAD MEDICARE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["ZZZRAILROAD MEDICARE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["ZZZRAILROAD MEDICARE","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZRAILROAD MEDICARE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["ZZZRAILROAD MEDICARE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["ZZZRAILROAD MEDICARE","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["ZZZRAILROAD MEDICARE","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["ZZZRAILROAD MEDICARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZRAILROAD MEDICARE","90853 - PR GROUP PSYCHOTHERAPY"]
["ZZZRAILROAD MEDICARE","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["ZZZRAILROAD MEDICARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["ZZZRAILROAD MEDICARE","97110 - PR THERAPEUTIC EXERCISES"]
["ZZZRAILROAD MEDICARE","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["ZZZRAILROAD MEDICARE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["ZZZRAILROAD MEDICARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZRAILROAD MEDICARE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["ZZZRAILROAD MEDICARE","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["ZZZRAILROAD MEDICARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["ZZZRAILROAD MEDICARE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["ZZZRAILROAD MEDICARE","A9500 - PR TC99M SESTAMIBI"]
["ZZZRAILROAD MEDICARE","A9513 - DELETED 2077"]
["ZZZRAILROAD MEDICARE","A9517 - PR I131 IODIDE CAP, RX"]
["ZZZRAILROAD MEDICARE","A9552 - PR F18 FDG"]
["ZZZRAILROAD MEDICARE","A9555 - PR RB82 RUBIDIUM"]
["ZZZRAILROAD MEDICARE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["ZZZRAILROAD MEDICARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ZZZRAILROAD MEDICARE","A9581 - PR GADOXETATE DISODIUM INJ"]
["ZZZRAILROAD MEDICARE","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["ZZZRAILROAD MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZRAILROAD MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZRAILROAD MEDICARE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["ZZZRAILROAD MEDICARE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["ZZZRAILROAD MEDICARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ZZZRAILROAD MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZUNITED","19120 - PR EXCISE BREAST CYST"]
["ZZZUNITED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["ZZZUNITED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["ZZZUNITED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZUNITED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["ZZZUNITED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["ZZZUNITED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["ZZZUNITED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["ZZZUNITED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["ZZZUNITED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["ZZZUNITED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZUNITED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["ZZZUNITED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["ZZZUNITED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZUNITED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["ZZZUNITED","70553 - CHG MRI BRAIN COMBO"]
["ZZZUNITED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["ZZZUNITED","72148 - CHG MRI, LUMBAR SPINE"]
["ZZZUNITED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["ZZZUNITED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["ZZZUNITED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["ZZZUNITED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["ZZZUNITED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["ZZZUNITED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["ZZZUNITED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["ZZZUNITED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZUNITED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["ZZZUNITED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["ZZZUNITED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZUNITED","80055 - CHG OBSTETRIC PANEL"]
["ZZZUNITED","80061 - CHG LIPID PANEL"]
["ZZZUNITED","80069 - CHG RENAL FUNCTION PANEL"]
["ZZZUNITED","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZUNITED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
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{"sheet":"CPT Pivot","index":12,"n_rows":18354,"n_cols":7,"rows_kept":2250,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
[]
[]
["Payer - Plan - Bill Type - Bill Code","Sum of Duplicates","Average of Gross Charge Amount","Average of Payer Charge Amount","Min of Minimum Charge Amount","Max of Maximum Charge Amount","Average of Self-Pay Charge"]
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["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
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["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
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["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - Q9967",9,1.2222222222222223,0.52333333333333343,0.12,456.36,0.30555555555555558]
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["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
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["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
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["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNICARE - UNICARE STANDARD - CPT - Q9967",9,1.2222222222222223,0.12000000000000001,0.12,456.36,0.30555555555555558]
["TRICARE EAST - TRICARE EAST SELECT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED - UNITED NAVIGATE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS CARELINK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
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["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
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["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS SELECT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
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["TUFTS - TUFTS SPIRIT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["UBH HPHC - UBH HPHC - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
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["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
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["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
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["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
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["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
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["HSN DENTAL - HSN DENTAL - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
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["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HSN - HSN STANDARD - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - Q9967",9,1.2222222222222223,0.68666666666666687,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HSN BAD DEBT - HSN BAD DEBT - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - Q9967",9,1.2222222222222223,0.68666666666666687,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["FALLON - FALLON COMMUNITY PLAN - CPT - Q9967",9,1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["HSN - HSN TEMPORARY - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["FALLON - FALLON HMO STANDARD - CPT - Q9967",9,1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["FALLON - FALLON POS STANDARD - CPT - Q9967",9,1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["FALLON - FALLON PPO STANDARD - CPT - Q9967",9,1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - Q9967",9,1.2222222222222223,0.68666666666666687,0.12,456.36,0.30555555555555558]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - Q9967",9,1.2222222222222223,0.68666666666666676,0.12,456.36,0.30555555555555558]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["FALLON SCO - FALLON SCO HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CIGNA - CIGNA LOCALPLUS - CPT - Q9967",9,1.2222222222222223,1.0388888888888888,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967",9,1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS INDEMNITY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CIGNA - CIGNA CARELINK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS SHIP PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CIGNA - CIGNA STANDARD - CPT - Q9967",9,1.2222222222222223,1.0388888888888888,0.12,456.36,0.30555555555555558]
["BCBS - BCBS STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA - CCA SCO ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA - CCA SCO STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA - ZZZCCA STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - Q9967",8,1.25,1.25,0.12,456.36,0.3125]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - Q9967",8,1.25,1.25,0.12,456.36,0.3125]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 45378",6,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 45378",6,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 55700",4,2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 85610",4,29,4.5,3.58,456.36,7.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 76830",4,1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 62322",4,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99205",4,899,173.23000000000002,23.27,899,224.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99215",4,595,153.80000000000001,23.27,595,148.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 62322",4,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 70553",4,6917,453.39,398.75,5879.45,1729.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 76700",4,1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 76700",4,1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 81002",4,17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 76805",4,1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99203",4,415,120.89000000000001,23.27,456.36,103.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 76830",4,1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99213",4,277,112.53999999999999,23.27,456.36,69.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81000",4,24,4.22,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - Q9963",4,1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81002",4,17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 55700",4,2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81003",4,17,2.36,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 70553",4,6917,453.39,398.75,5879.45,1729.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 85610",4,29,4.5,3.58,456.36,7.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 76805",4,1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 85730",4,42,6.31,5.3,456.36,10.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 81000",4,24,4.22,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99203",4,415,120.89,23.27,456.36,103.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 81003",4,17,2.36,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99204",4,705,147.94,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 85730",4,42,6.31,5.3,456.36,10.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99205",4,899,173.23000000000002,23.27,899,224.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99204",4,705,147.94,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99212",4,147,96.429999999999993,23.27,456.36,36.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99212",4,147,96.429999999999993,23.27,456.36,36.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99213",4,277,112.53999999999999,23.27,456.36,69.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99214",4,422,128.995,23.27,456.36,105.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99215",4,595,153.80000000000001,23.27,595,148.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - A9579",4,4,4,1.08,456.36,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - A9579",4,4,4,1.08,456.36,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - Q9963",4,1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99214",4,422,128.995,23.27,456.36,105.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 45378",3,2154,1830.9000000000003,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA POS - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 45378",3,2154,1139.47,395.43,2154,538.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["WELLCARE - WELLCARE STANDARD - CPT - 45378",3,2154,1067.25,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 45378",3,2154,775.44,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 45378",3,2154,1830.9000000000003,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 45378",3,2154,947.64,395.43,2154,538.5]
["TUFTS - TUFTS POS - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 45378",3,2154,1231.44,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["TUFTS - TUFTS PPO - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["MEDICARE - MEDICARE PART B ONLY - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["WELLCARE - WELLCARE HMO - CPT - 45378",3,2154,1067.25,395.43,2154,538.5]
["TUFTS - TUFTS CARELINK - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["TUFTS - TUFTS SELECT - CPT - 45378",3,2154,736.24000000000012,395.43,2154,538.5]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS - TUFTS HMO - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 45378",3,2154,1231.44,395.43,2154,538.5]
["UNITED - UNITED HP SHIP - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["TUFTS - TUFTS SPIRIT - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED - UNITED NAVIGATE - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED - UNITED PASSPORT CONNECT - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["UNITED - UNITED STANDARD - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 45378",3,2154,947.64,395.43,2154,538.5]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 45378",3,2154,947.64,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UBH HPHC - UBH HPHC - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNICARE - UNICARE STANDARD - CPT - 45378",3,2154,1020.59,395.43,2154,538.5]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 45378",3,2154,861.6,395.43,2154,538.5]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED - UNITED DEFINITY HRA - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["WELLCARE - WELLCARE PPO - CPT - 45378",3,2154,1067.25,395.43,2154,538.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["FALLON - FALLON PPO STANDARD - CPT - 45378",3,2154,1077,395.43,2154,538.5]
["FALLON SCO - FALLON SCO HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["MEDICARE - MEDICARE PART A ONLY - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["FALLON - FALLON COMMUNITY PLAN - CPT - 45378",3,2154,1077,395.43,2154,538.5]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["HSN DENTAL - HSN DENTAL - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["FALLON - FALLON HMO STANDARD - CPT - 45378",3,2154,1077,395.43,2154,538.5]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 45378",3,2154,1213.1300000000001,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 45378",3,2154,1213.1300000000001,395.43,2154,538.5]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 45378",3,2154,1213.1300000000001,395.43,2154,538.5]
["FALLON - FALLON POS STANDARD - CPT - 45378",3,2154,1077,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 45378",3,2154,1213.1300000000001,395.43,2154,538.5]
["HSN - HSN STANDARD - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["MEDICARE - MEDICARE A&B - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HSN - HSN TEMPORARY - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA - AETNA HMO - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 45378",3,2154,1128.82,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CIGNA - CIGNA CARELINK - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BCBS INDEMNITY - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CCA - CCA SCO ONECARE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378",3,2154,1139.47,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["BCBS - BCBS HMO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CCA - CCA SCO STANDARD - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BCBS POS - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CCA - ZZZCCA STANDARD - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA - AETNA POS - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA MCR SUPP - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BCBS PPO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA - AETNA PPO EPO - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CIGNA - CIGNA LOCALPLUS - CPT - 45378",3,2154,1830.9000000000003,395.43,2154,538.5]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BCBS STANDARD - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["BCBS - BCBS SHIP PPO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CIGNA - CIGNA STANDARD - CPT - 45378",3,2154,1830.9000000000003,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 45378",3,2154,1128.82,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 81003",2,17,2.38,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99215",2,595,505.75,23.27,595,148.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 76830",2,1028,873.8,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99205",2,899,155.85,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 62322",2,1426,1212.0999999999999,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99203",2,415,27.28,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99215",2,595,595,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 76830",2,1028,272.94,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 85730",2,42,6.36,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO BI/LAHEY - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 99213",2,277,155.85,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 85610",2,29,4.34,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 76700",2,1131,353.57,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99205",2,899,764.15,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 99205",2,899,328.17,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99215",2,595,595,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76830",2,1028,272.94,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 81000",2,24,4.26,2.89,456.36,6]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 3 - CPT - 85610",2,29,4.54,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA POS - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 81002",2,17,3.68,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99215",2,595,155.85,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 99203",2,415,155.85,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 76830",2,1028,873.8,113.99,873.8,257]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99205",2,899,764.15,23.27,899,224.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO BI/LAHEY - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 81002",2,17,9.51,2.34,456.36,4.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99213",2,277,27.28,23.27,456.36,69.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 62322",2,1426,1212.0999999999999,82.95,1426,356.5]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 85610",2,29,4.34,3.58,456.36,7.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99215",2,595,505.75,23.27,595,148.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO COMM - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99215",2,595,595,23.27,595,148.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WELLCARE - WELLCARE PPO - CPT - 99215",2,595,154.36000000000001,23.27,595,148.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 55700",2,2348,845.28,420.34,3848.68,587]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 62322",2,1426,513.36,82.95,1426,356.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 70553",2,6917,2490.12,398.75,5879.45,1729.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 76700",2,1131,407.16,111.92,961.35,282.75]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 76805",2,1192,429.12,113.99,1013.2,298]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 76830",2,1028,370.08,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 81000",2,24,2.89,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 85610",2,29,3.86,3.58,456.36,7.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 81002",2,17,2.34,2.34,456.36,4.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 99215",2,595,328.17,23.27,595,148.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 81003",2,17,1.63,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 85610",2,29,3.58,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 85730",2,42,5.48,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99203",2,415,415,23.27,456.36,103.75]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99204",2,705,705,23.27,705,176.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SIG - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99212",2,147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99213",2,277,277,23.27,456.36,69.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99214",2,422,422,23.27,456.36,105.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99215",2,595,595,23.27,595,148.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85610",2,29,3.86,3.58,456.36,7.25]
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["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - Q9963",2,1,0.36,0.22,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLCARE - WELLCARE PPO - CPT - A9579",2,4,4,1.08,456.36,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLCARE - WELLCARE PPO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 1 - CPT - 85610",2,29,4.54,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 55700",2,2348,2286.9499999999998,420.34,3848.68,587]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 70553",2,6917,431.8,398.75,5879.45,1729.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 81000",2,24,4.0199999999999996,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 85730",2,42,6.01,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 81003",2,17,2.38,1.63,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - A9579",2,4,4,1.08,456.36,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLCARE - WELLCARE PPO - CPT - 99212",2,147,154.36000000000001,23.27,456.36,36.75]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLCARE - WELLCARE PPO - CPT - 99213",2,277,154.36000000000001,23.27,456.36,69.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 3 - CPT - 81002",2,17,3.68,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 55700",2,2348,2286.9499999999998,420.34,3848.68,587]
["ZZZAETNA - ZZZAETNA HMO - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 70553",2,6917,431.8,398.75,5879.45,1729.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["ZZZAETNA - ZZZAETNA HMO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 81000",2,24,4.0199999999999996,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 85730",2,42,6.01,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 81000",2,24,4.26,2.89,456.36,6]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["ZZZAETNA - ZZZAETNA POS - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - A9579",2,4,4,1.08,456.36,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLCARE - WELLCARE STANDARD - CPT - 55700",2,2348,2378.4299999999998,420.34,3848.68,587]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLCARE - WELLCARE STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 85730",2,42,6.36,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - Q9963",2,1,0.53,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 85730",2,42,8.3800000000000008,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 85610",2,29,4.54,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99203",2,415,100,23.27,456.36,103.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99204",2,705,150.71,23.27,705,176.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99205",2,899,188.86,23.27,899,224.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99203",2,415,155.85,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99212",2,147,41.58,23.27,456.36,36.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99213",2,277,155.85,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99215",2,595,132.82,23.27,595,148.75]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - A9579",2,4,1.71,1.08,456.36,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 99205",2,899,155.85,23.27,899,224.75]
["WELLCARE - WELLCARE STANDARD - CPT - 70553",2,6917,449.08,398.75,5879.45,1729.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 99215",2,595,155.85,23.27,595,148.75]
["WELLCARE - WELLCARE STANDARD - CPT - 76700",2,1131,128.38,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO BI/LAHEY - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 76700",2,1131,961.35,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 81002",2,17,2.83,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99203",2,415,352.75,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99213",2,277,235.45,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - Q9963",2,1,0.85,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 76830",2,1028,352.8,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 85610",2,29,11.73,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99205",2,899,27.28,23.27,899,224.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99215",2,595,27.28,23.27,595,148.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 85730",2,42,8.3800000000000008,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99203",2,415,100,23.27,456.36,103.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 76700",2,1131,961.35,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99204",2,705,150.71,23.27,705,176.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 81002",2,17,2.83,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99205",2,899,188.86,23.27,899,224.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99203",2,415,352.75,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99212",2,147,41.58,23.27,456.36,36.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99213",2,277,235.45,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - Q9963",2,1,0.85,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99215",2,595,132.82,23.27,595,148.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - A9579",2,4,1.71,1.08,456.36,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLCARE - WELLCARE STANDARD - CPT - 76805",2,1192,128.38,113.99,1013.2,298]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLCARE - WELLCARE STANDARD - CPT - 76830",2,1028,128.38,113.99,873.8,257]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO COMM - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 99205",2,899,899,23.27,899,224.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 99215",2,595,595,23.27,595,148.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 85730",2,42,8.3800000000000008,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO COMM - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99203",2,415,100,23.27,456.36,103.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99204",2,705,150.71,23.27,705,176.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99205",2,899,188.86,23.27,899,224.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99212",2,147,41.58,23.27,456.36,36.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99215",2,595,132.82,23.27,595,148.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - A9579",2,4,1.71,1.08,456.36,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLCARE - WELLCARE STANDARD - CPT - 81000",2,24,4.18,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99215",2,595,595,23.27,595,148.75]
["WELLCARE - WELLCARE STANDARD - CPT - 81002",2,17,3.62,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 99204",2,705,150.71,23.27,705,176.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 1 - CPT - 81003",2,17,2.38,1.63,456.36,4.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 81000",2,24,4.43,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["ZZZAETNA - ZZZAETNA POS - CPT - 81000",2,24,12.7,2.89,456.36,6]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLCARE - WELLCARE STANDARD - CPT - A9579",2,4,4,1.08,456.36,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99212",2,147,77.760000000000005,23.27,456.36,36.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 85730",2,42,8.3800000000000008,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 55700",2,2348,2401.3000000000002,420.34,3848.68,587]
["WELLSENSE - WELLSENSE CHOICE - CPT - 81003",2,17,2.38,1.63,456.36,4.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99212",2,147,124.95,23.27,456.36,36.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 85730",2,42,16.440000000000001,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - A9579",2,4,1.71,1.08,456.36,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 81003",2,17,6.81,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 76805",2,1192,220.4,113.99,1013.2,298]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 70553",2,6917,755.93,398.75,5879.45,1729.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - A9579",2,4,4,1.08,456.36,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 76805",2,1192,272.94,113.99,1013.2,298]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 85730",2,42,8.3800000000000008,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 99214",2,422,422,23.27,456.36,105.5]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99204",2,705,705,23.27,705,176.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81003",2,17,6.81,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - A9579",2,4,4,1.08,456.36,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 55700",2,2348,2744.34,420.34,3848.68,587]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 85610",2,29,5.15,3.58,456.36,7.25]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 55700",2,2348,2286.9499999999998,420.34,3848.68,587]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 76805",2,1192,148.13,113.99,1013.2,298]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 99205",2,899,178.11,23.27,899,224.75]
["UNITED - UNITED STANDARD - CPT - 70553",2,6917,954.74,398.75,5879.45,1729.25]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 81003",2,17,2.71,1.63,456.36,4.25]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 99213",2,277,137.06,23.27,456.36,69.25]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 76805",2,1192,113.99,113.99,1013.2,298]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 99205",2,899,137.06,23.27,899,224.75]
["UBH HPHC - UBH HPHC - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 81003",2,17,2.71,1.63,456.36,4.25]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 99215",2,595,137.06,23.27,595,148.75]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 85730",2,42,6.01,5.3,456.36,10.5]
["MEDICARE - MEDICARE PART B ONLY - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 85730",2,42,6.01,5.3,456.36,10.5]
["TUFTS - TUFTS HMO - CPT - 99215",2,595,27.28,23.27,595,148.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["TUFTS - TUFTS POS - CPT - 99204",2,705,27.28,23.27,705,176.25]
["MEDICARE - MEDICARE PART B ONLY - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["UBH HPHC - UBH HPHC - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["TUFTS - TUFTS SELECT - CPT - 76700",2,1131,133.54,111.92,961.35,282.75]
["UNITED - UNITED HP SHIP - CPT - 99214",2,422,422,23.27,456.36,105.5]
["UNITED - UNITED NAVIGATE - CPT - 81003",2,17,2.0299999999999998,1.63,456.36,4.25]
["TUFTS - TUFTS SPIRIT - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["TUFTS - TUFTS SPIRIT - CPT - 99214",2,422,102.14,23.27,456.36,105.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 76700",2,1131,420.34,111.92,961.35,282.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 81002",2,17,4.16,2.34,456.36,4.25]
["WELLCARE - WELLCARE HMO - CPT - 85730",2,42,6.25,5.3,456.36,10.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 99203",2,415,420.34,23.27,456.36,103.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 81002",2,17,4.82,2.34,456.36,4.25]
["TUFTS TOGETHER ACO - TUFTS TOGETHER ACO UMASS MEMORIAL - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 99214",2,422,102.14,23.27,456.36,105.5]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 99203",2,415,420.34,23.27,456.36,103.75]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 70553",2,6917,420.34,398.75,5879.45,1729.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 99212",2,147,420.34,23.27,456.36,36.75]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["UBH HPHC - UBH HPHC - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 99213",2,277,69.23,23.27,456.36,69.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 70553",2,6917,420.34,398.75,5879.45,1729.25]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["UNITED - UNITED HP SHIP - CPT - 99215",2,595,595,23.27,595,148.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 81000",2,24,5.57,2.89,456.36,6]
["UNITED - UNITED NAVIGATE - CPT - 81002",2,17,3.13,2.34,456.36,4.25]
["UNITED - UNITED PASSPORT CONNECT - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["UNITED - UNITED PASSPORT CONNECT - CPT - 99213",2,277,277,23.27,456.36,69.25]
["UNITED - UNITED STANDARD - CPT - 99215",2,595,328.17,23.27,595,148.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 81000",2,24,5.57,2.89,456.36,6]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 85730",2,42,7.18,5.3,456.36,10.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 99213",2,277,110.8,23.27,456.36,69.25]
["WELLCARE - WELLCARE HMO - CPT - 99203",2,415,154.36000000000001,23.27,456.36,103.75]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 81003",2,17,2.36,1.63,456.36,4.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 99204",2,705,147.94,23.27,705,176.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 85730",2,42,456.36,5.3,456.36,10.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 99204",2,705,705,23.27,705,176.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 99204",2,705,147.94,23.27,705,176.25]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 99214",2,422,128.995,23.27,456.36,105.5]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 81000",2,24,4.0199999999999996,2.89,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 99203",2,415,120.89,23.27,456.36,103.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 99205",2,899,173.23000000000002,23.27,899,224.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 70553",2,6917,3895.65,398.75,5879.45,1729.25]
["MEDICAID ACO - MEDICAID ACO STEWRD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 99214",2,422,128.995,23.27,456.36,105.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 55700",2,2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["HSN - HSN TEMPORARY - CPT - 81003",2,17,456.36,1.63,456.36,4.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 70553",2,6917,453.39,398.75,5879.45,1729.25]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 81003",2,17,456.36,1.63,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 76805",2,1192,129.61000000000001,113.99,1013.2,298]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 99213",2,277,112.53999999999999,23.27,456.36,69.25]
["FALLON - FALLON HMO STANDARD - CPT - 70553",2,6917,3458.5,398.75,5879.45,1729.25]
["FALLON - FALLON HMO STANDARD - CPT - 99203",2,415,207.5,23.27,456.36,103.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 81003",2,17,9.57,1.63,456.36,4.25]
["FALLON - FALLON POS STANDARD - CPT - 81000",2,24,12,2.89,456.36,6]
["FALLON - FALLON POS STANDARD - CPT - 99213",2,277,138.5,23.27,456.36,69.25]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG FAM ASSIS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["FALLON - FALLON PPO STANDARD - CPT - 85610",2,29,14.5,3.58,456.36,7.25]
["MEDICARE - MEDICARE A&B - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO BRKSHRE - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 55700",2,2348,3848.68,420.34,3848.68,587]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 76805",2,1192,129.61000000000001,113.99,1013.2,298]
["HSN - HSN STANDARD - CPT - 99205",2,899,456.36,23.27,899,224.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["FALLON MEDICAID MANAGED - FALLON MCD MNG STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 76700",2,1131,456.36,111.92,961.35,282.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 99213",2,277,112.53999999999999,23.27,456.36,69.25]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 99203",2,415,456.36,23.27,456.36,103.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 81002",2,17,456.36,2.34,456.36,4.25]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 62322",2,1426,803.12,82.95,1426,356.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - Q9963",2,1,0.56000000000000005,0.22,456.36,0.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGH HLTHPLAN MCD MNG CMA - CPT - 81000",2,24,3.55,2.89,456.36,6]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 99204",2,705,705,23.27,705,176.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM MCD MNG STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 99214",2,422,422,23.27,456.36,105.5]
["MEDICAID - MEDICAID CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["MEDICAID - MEDICAID SENIOR BUY-IN - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["MEDICAID ACO - MEDICAID ACO COMM - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 99214",2,422,422,23.27,456.36,105.5]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 85730",2,42,16.39,5.3,456.36,10.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["MEDICAID MANAGED CARE - MCD MNG CARE STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["MEDICARE - MEDICARE A&B - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["AETNA - AETNA PPO EPO - CPT - 81000",2,24,12.7,2.89,456.36,6]
["AETNA - AETNA PPO EPO - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 90837",2,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70553",2,6917,431.8,398.75,5879.45,1729.25]
["AETNA - AETNA HMO - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - J3301",2,18,18,0.98,456.36,4.5]
["BCBS - BCBS HMO - CPT - 81000",2,24,6.3,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 99203",2,415,120.89,23.27,456.36,103.75]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 99203",2,415,120.89,23.27,456.36,103.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 72193",2,3040,216.61,190.5,2584,760]
["BCBS - BCBS POS - CPT - 81000",2,24,6.3,2.89,456.36,6]
["AETNA - AETNA MCR SUPP - CPT - A9579",2,4,4,1.08,456.36,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["BCBS - BCBS PPO - CPT - 85730",2,42,12.03,5.3,456.36,10.5]
["BCBS - BCBS PPO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["BCBS - BCBS SHIP PPO - CPT - 99204",2,705,32.18,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 76700",2,1131,135.79,111.92,961.35,282.75]
["BCBS - BCBS STANDARD - CPT - 85730",2,42,12.03,5.3,456.36,10.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 99212",2,147,32.18,23.27,456.36,36.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 76805",2,1192,129.61000000000001,113.99,1013.2,298]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9579",2,4,4,1.08,456.36,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["AETNA - AETNA MCR SUPP - CPT - 99214",2,422,223.24,23.27,456.36,105.5]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 99215",2,595,153.80000000000001,23.27,595,148.75]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 76830",2,1028,128.66,113.99,873.8,257]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 99203",2,415,120.89,23.27,456.36,103.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 85610",2,29,7.45,3.58,456.36,7.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - A9579",2,4,4,1.08,456.36,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 81003",2,17,4.58,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 76805",2,1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 55700",2,2348,2515.65,420.34,3848.68,587]
["CCA - CCA SCO ONECARE - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 99204",2,705,147.94,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 81003",2,17,2.36,1.63,456.36,4.25]
["CCA - CCA SCO STANDARD - CPT - 99205",2,899,155.85,23.27,899,224.75]
["CCA - ZZZCCA STANDARD - CPT - 55700",2,2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 99214",2,422,128.995,23.27,456.36,105.5]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - A9579",2,4,4,1.08,456.36,1]
["AETNA - AETNA HMO - CPT - 70553",2,6917,3659.09,398.75,5879.45,1729.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 99205",2,899,155.85,23.27,899,224.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 90715",2,180,180,39.75,456.36,45]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - A9513",2,429,304.95999999999998,154.44,456.36,107.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 99215",2,595,155.85,23.27,595,148.75]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 76805",2,1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 72110",2,595,129.61000000000001,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9579",2,4,4,1.08,456.36,1]
["CIGNA - CIGNA CARELINK - CPT - 99205",2,899,27.28,23.27,899,224.75]
["CIGNA - CIGNA LOCALPLUS - CPT - 76700",2,1131,961.35,111.92,961.35,282.75]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 81000",2,24,4.22,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["CIGNA - CIGNA STANDARD - CPT - 81002",2,17,2.83,2.34,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 99212",2,147,96.429999999999993,23.27,456.36,36.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 99204",2,705,147.94,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 99203",2,415,120.89,23.27,456.36,103.75]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 55700",2,2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 99214",2,422,128.995,23.27,456.36,105.5]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 99212",2,147,96.429999999999993,23.27,456.36,36.75]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 70553",2,6917,453.39,398.75,5879.45,1729.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 99203",2,415,120.89,23.27,456.36,103.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 55700",2,2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9579",2,4,4,1.08,456.36,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 99205",2,899,173.23000000000002,23.27,899,224.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 80053",1,271,143.36000000000001,9.31,456.36,67.75]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 80055",1,260,111.12,18.32,456.36,65]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 90832",1,168,71.8,21.97,456.36,42]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - A9500",1,357,152.58000000000001,128.52000000000001,456.36,89.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - J3301",1,18,7.69,0.98,456.36,4.5]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 80069",1,195,12.13,7.66,456.36,48.75]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 64483",1,1545,660.33,420.34,1879.97,386.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 74177",1,3263,1394.61,398.75,2773.55,815.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 80053",1,271,14.77,9.31,456.36,67.75]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 84153",1,125,25.7,13.26,456.36,31.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 90832",1,168,71.8,21.97,456.36,42]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 84443",1,114,60.31,14.82,456.36,28.5]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - A9500",1,357,152.58000000000001,128.52000000000001,456.36,89.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 43235",1,1505,643.24,420.34,1871.88,376.25]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 64483",1,1545,660.33,420.34,1879.97,386.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - J1030",1,13,13,4.68,456.36,3.25]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 84153",1,125,25.7,13.26,456.36,31.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 72110",1,595,272.94,46.45,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9575",1,8,8,0.13,456.36,2]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - J1030",1,13,5.56,4.68,456.36,3.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 43235",1,1505,643.24,420.34,1871.88,376.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 62323",1,1485,785.57,420.34,1505.24,371.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 43239",1,1712,731.71,420.34,1871.88,428]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 80053",1,271,14.77,9.31,456.36,67.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["WELLCARE - WELLCARE PPO - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 97110",1,249,23.1,23.1,456.36,62.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 80069",1,195,23.75,7.66,456.36,48.75]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - J1030",1,13,5.56,4.68,456.36,3.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 77066",1,924,394.92,131.5,924,231]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 72193",1,3040,206.3,190.5,2584,760]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 73721",1,5064,578.29999999999995,254.07,4304.3999999999996,1266]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 43239",1,1712,731.71,420.34,1871.88,428]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 90715",1,180,76.930000000000007,39.75,456.36,45]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 97110",1,249,23.1,23.1,456.36,62.25]
["WELLCARE - WELLCARE STANDARD - CPT - 70450",1,2022,128.38,113.99,1718.7,505.5]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - A9581",1,99,42.31,15.3,456.36,24.75]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 80069",1,195,26.35,7.66,456.36,48.75]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 62323",1,1485,634.69000000000005,420.34,1505.24,371.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 73721",1,5064,578.29999999999995,254.07,4304.3999999999996,1266]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 43235",1,1505,1505,420.34,1871.88,376.25]
["WELLCARE - WELLCARE STANDARD - CPT - 72148",1,4633,286.14,254.07,3938.05,1158.25]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 90715",1,180,76.930000000000007,39.75,456.36,45]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 90853",1,129,100.08,15.63,456.36,32.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 80069",1,195,103.16,7.66,456.36,48.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99386",1,640,338.56,23.27,640,160]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 74177",1,3263,1726.13,398.75,2773.55,815.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 62323",1,1485,634.69000000000005,420.34,1505.24,371.25]
["WELLCARE - WELLCARE STANDARD - CPT - A9581",1,99,99,15.3,456.36,24.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 90715",1,180,76.930000000000007,39.75,456.36,45]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 80069",1,195,9.19,7.66,456.36,48.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 81001",1,24,3.33,2.8,456.36,6]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - P9047",1,180,55.73,50.13,456.36,45]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 99385",1,530,226.52,23.27,530,132.5]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - Q9958",1,1,0.43,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 29881",1,5454,2331.04,420.34,5454,1363.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 80048",1,167,11.83,7.46,456.36,41.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 72148",1,4633,770.9,254.07,3938.05,1158.25]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 80048",1,167,11.83,7.46,456.36,41.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 45385",1,3040,2584,420.34,2929.62,760]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - A9513",1,429,183.35,154.44,456.36,107.25]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 95810",1,3935,774.82,420.34,3344.75,983.75]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 99385",1,530,226.52,23.27,530,132.5]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 73721",1,5064,578.29999999999995,254.07,4304.3999999999996,1266]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 77065",1,752,102.59,102.59,752,188]
["WELLCARE - WELLCARE STANDARD - CPT - 62323",1,1485,807.53,420.34,1505.24,371.25]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 72193",1,3040,332.53,190.5,2584,760]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 80048",1,167,11.83,7.46,456.36,41.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - A9500",1,357,152.58000000000001,128.52000000000001,456.36,89.25]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 90686",1,74,31.63,19.16,456.36,18.5]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 95810",1,3935,774.82,420.34,3344.75,983.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 66984",1,2224,950.54,420.34,4241.13,556]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - Q9966",1,1,0.43,0.36,456.36,0.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 3 - CPT - 81001",1,24,3.36,2.8,456.36,6]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 72193",1,3040,332.53,190.5,2584,760]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 90853",1,129,100.08,15.63,456.36,32.25]
["WELLCARE - WELLCARE STANDARD - CPT - 84153",1,125,19.13,13.26,456.36,31.25]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 90686",1,74,31.63,19.16,456.36,18.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 29881",1,5454,5454,420.34,5454,1363.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 84153",1,125,50.24,13.26,456.36,31.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 77067",1,488,488,108.47,488,122]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 80061",1,129,40.630000000000003,11.81,456.36,32.25]
["WELLCARE - WELLCARE STANDARD - CPT - 84443",1,114,17.47,14.82,456.36,28.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 73721",1,5064,451.66,254.07,4304.3999999999996,1266]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - A9581",1,99,42.31,15.3,456.36,24.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 80076",1,163,7.21,7.21,456.36,40.75]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 90686",1,74,31.63,19.16,456.36,18.5]
["ZZZAETNA - ZZZAETNA POS - CPT - 45380",1,2575,1362.18,420.34,2575,643.75]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 80061",1,129,14.17,11.81,456.36,32.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 19120",1,4199,1794.65,420.34,6229.57,1049.75]
["ZZZAETNA - ZZZAETNA POS - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 70450",1,2022,1069.6400000000001,113.99,1718.7,505.5]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 77067",1,488,208.57,108.47,488,122]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 84443",1,114,14.82,14.82,456.36,28.5]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - A9517",1,523,276.67,20.12,456.36,130.75]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 93452",1,6358,2717.41,420.34,6358,1589.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 80076",1,163,7.21,7.21,456.36,40.75]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 85025",1,55,29.1,6.85,456.36,13.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 66984",1,2224,2616.5500000000002,420.34,4241.13,556]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 43235",1,1505,643.24,420.34,1871.88,376.25]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 72148",1,4633,579.80999999999995,254.07,3938.05,1158.25]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 77067",1,488,208.57,108.47,488,122]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 90837",1,215,91.89,27.84,456.36,53.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 90662",1,129,55.13,36.119999999999997,456.36,32.25]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 93452",1,6358,2717.41,420.34,6358,1589.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 90834",1,215,179.02,27.84,456.36,53.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 80053",1,271,11.17,9.31,456.36,67.75]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 64483",1,1545,660.33,420.34,1879.97,386.25]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 72148",1,4633,579.80999999999995,254.07,3938.05,1158.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 81001",1,24,3.33,2.8,456.36,6]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 90662",1,129,55.13,36.119999999999997,456.36,32.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 64483",1,1545,1313.25,420.34,1879.97,386.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 80055",1,260,18.32,18.32,456.36,65]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - A9575",1,8,3.42,0.13,456.36,2]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99386",1,640,640,23.27,640,160]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 43235",1,1505,1505.24,420.34,1871.88,376.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 70450",1,2022,352.8,113.99,1718.7,505.5]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 84443",1,114,45.94,14.82,456.36,28.5]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 81001",1,24,4.43,2.8,456.36,6]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - J1030",1,13,13,4.68,456.36,3.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 64483",1,1545,1313.25,420.34,1879.97,386.25]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 85027",1,45,6.85,5.71,456.36,11.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 90715",1,180,153,39.75,456.36,45]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - A9575",1,8,3.42,0.13,456.36,2]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99386",1,640,640,23.27,640,160]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 43235",1,1505,643.24,420.34,1871.88,376.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 72110",1,595,46.45,46.45,595,148.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 77066",1,924,394.92,131.5,924,231]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 81001",1,24,4.43,2.8,456.36,6]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - J1030",1,13,5.56,4.68,456.36,3.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 64483",1,1545,1023.42,420.34,1879.97,386.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 90715",1,180,180,39.75,456.36,45]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - A9513",1,429,290.44,154.44,456.36,107.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 45391",1,2924,1249.72,420.34,2924,731]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 74177",1,3263,755.93,398.75,2773.55,815.75]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 77066",1,924,394.92,131.5,924,231]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 97110",1,249,23.1,23.1,456.36,62.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - P9047",1,180,52.45,50.13,456.36,45]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 90853",1,129,55.13,15.63,456.36,32.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 80055",1,260,130.57,18.32,456.36,65]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 90834",1,215,108.15,27.84,456.36,53.75]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - Q9966",1,1,0.43,0.36,456.36,0.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 43235",1,1505,1871.88,420.34,1871.88,376.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 74177",1,3263,755.93,398.75,2773.55,815.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 80048",1,167,11.83,7.46,456.36,41.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 73721",1,5064,578.29999999999995,254.07,4304.3999999999996,1266]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 81001",1,24,2.89,2.8,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 64483",1,1545,1879.97,420.34,1879.97,386.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 80055",1,260,130.57,18.32,456.36,65]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - A9555",1,1385,591.95000000000005,420.34,1385,346.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - Q9966",1,1,0.43,0.36,456.36,0.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 43235",1,1505,1017.81,420.34,1871.88,376.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 90837",1,215,77.400000000000006,27.84,456.36,53.75]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 77065",1,752,321.39999999999998,102.59,752,188]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 90837",1,215,179.02,27.84,456.36,53.75]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - P9047",1,180,53.08,50.13,456.36,45]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 66984",1,2224,2224,420.34,4241.13,556]
["WELLCARE - WELLCARE PPO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - A9555",1,1385,591.95000000000005,420.34,1385,346.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["ZZZAETNA - ZZZAETNA HMO - CPT - 45385",1,3040,1608.16,420.34,2929.62,760]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 85027",1,45,17.649999999999999,5.71,456.36,11.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 80069",1,195,103.16,7.66,456.36,48.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 90847",1,363,192.03,30.9,456.36,90.75]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 85027",1,45,9.0399999999999991,5.71,456.36,11.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 90846",1,308,154.91999999999999,30.9,456.36,77]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 45385",1,3040,1608.16,420.34,2929.62,760]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 66984",1,2224,2616.5500000000002,420.34,4241.13,556]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85027",1,45,17.649999999999999,5.71,456.36,11.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - J1030",1,13,5.56,4.68,456.36,3.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 19120",1,4199,1794.65,420.34,6229.57,1049.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 90847",1,363,192.03,30.9,456.36,90.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80069",1,195,7.81,7.66,456.36,48.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90846",1,308,308,30.9,456.36,77]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 80061",1,129,13.39,11.81,456.36,32.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 95810",1,3935,420.34,420.34,3344.75,983.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 80076",1,163,7.35,7.21,456.36,40.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 90662",1,129,57.77,36.119999999999997,456.36,32.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 29881",1,5454,420.34,420.34,5454,1363.5]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 90837",1,215,215,27.84,456.36,53.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 72193",1,3040,420.34,190.5,2584,760]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST - CPT - 80076",1,163,7.21,7.21,456.36,40.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 97110",1,249,32.11,23.1,456.36,62.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 90686",1,74,420.34,19.16,456.36,18.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 85027",1,45,6.47,5.71,456.36,11.25]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - A9517",1,523,55.6,20.12,456.36,130.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA FAM ASSIST - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY COMMONHLTH - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["UNICARE - UNICARE STANDARD - CPT - 90837",1,215,161.25,27.84,456.36,53.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 77067",1,488,420.34,108.47,488,122]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 66821",1,2811,652.66,420.34,2389.35,702.75]
["UNITED - UNITED PASSPORT CONNECT - CPT - J3301",1,18,18,0.98,456.36,4.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 93452",1,6358,420.34,420.34,6358,1589.5]
["MEDICARE - MEDICARE PART B ONLY - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 77066",1,924,131.5,131.5,924,231]
["TUFTS - TUFTS SPIRIT - CPT - 95810",1,3935,1173.94,420.34,3344.75,983.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 70450",1,2022,148.13,113.99,1718.7,505.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 66984",1,2224,3623.14,420.34,4241.13,556]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 77067",1,488,108.47,108.47,488,122]
["TUFTS - TUFTS HMO - CPT - 72193",1,3040,558.08000000000004,190.5,2584,760]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO CARE PLUS - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 97110",1,249,44.46,23.1,456.36,62.25]
["UNICARE - UNICARE STANDARD - CPT - 66821",1,2811,2108.25,420.34,2389.35,702.75]
["UNITED - UNITED DEFINITY HRA - CPT - 45380",1,2575,2575,420.34,2575,643.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 43239",1,1712,420.34,420.34,1871.88,428]
["UNITED - UNITED HP SHIP - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["TUFTS - TUFTS POS - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 85025",1,55,9.32,6.85,456.36,13.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 80061",1,129,16,11.81,456.36,32.25]
["UNITED - UNITED PASSPORT CONNECT - CPT - 90715",1,180,180,39.75,456.36,45]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 90834",1,215,420.34,27.84,456.36,53.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 90847",1,363,214.82,30.9,456.36,90.75]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 74177",1,3263,431.8,398.75,2773.55,815.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 43239",1,1712,1409.36,420.34,1871.88,428]
["TUFTS - TUFTS SPIRIT - CPT - 43235",1,1505,1017.81,420.34,1871.88,376.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - A9513",1,429,348.53,154.44,456.36,107.25]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - A9517",1,523,21.34,20.12,456.36,130.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 84443",1,114,23.26,14.82,456.36,28.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 90846",1,308,247.88,30.9,456.36,77]
["WELLCARE - WELLCARE HMO - CPT - 85025",1,55,8.08,6.85,456.36,13.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 90837",1,215,420.34,27.84,456.36,53.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA CARE PLUS - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA FAM ASSIST - CPT - 81001",1,24,2.8,2.8,456.36,6]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY - CPT - 84443",1,114,14.82,14.82,456.36,28.5]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 64483",1,1545,1228.0999999999999,420.34,1879.97,386.25]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["UBH HPHC - UBH HPHC - CPT - 45391",1,2924,1324.99,420.34,2924,731]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - A9555",1,1385,420.34,420.34,1385,346.25]
["UBH HPHC - UBH HPHC - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["UNICARE - UNICARE STANDARD - CPT - 81001",1,24,5.58,2.8,456.36,6]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 80055",1,260,57.37,18.32,456.36,65]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 77065",1,752,102.59,102.59,752,188]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 80048",1,167,11.71,7.46,456.36,41.75]
["UNITED - UNITED HP SHIP - CPT - 72193",1,3040,395.2,190.5,2584,760]
["UNITED - UNITED HP SHIP - CPT - 97110",1,249,145.28,23.1,456.36,62.25]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 90832",1,168,214.82,21.97,456.36,42]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 90662",1,129,73.400000000000006,36.119999999999997,456.36,32.25]
["UNITED - UNITED NAVIGATE - CPT - 19120",1,4199,4199,420.34,6229.57,1049.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 62323",1,1485,420.34,420.34,1505.24,371.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 73721",1,5064,420.34,254.07,4304.3999999999996,1266]
["UNITED - UNITED PASSPORT CONNECT - CPT - 80048",1,167,25.66,7.46,456.36,41.75]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 90853",1,129,100.08,15.63,456.36,32.25]
["TUFTS - TUFTS PPO - CPT - 95810",1,3935,2717.96,420.34,3344.75,983.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 97110",1,249,420.34,23.1,456.36,62.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 99386",1,640,420.34,23.27,640,160]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 90834",1,215,179.02,27.84,456.36,53.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 45385",1,3040,1324.99,420.34,2929.62,760]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 62323",1,1485,1075.18,420.34,1505.24,371.25]
["TUFTS - TUFTS SELECT - CPT - 84153",1,125,19,13.26,456.36,31.25]
["TUFTS - TUFTS SELECT - CPT - 90832",1,168,21.97,21.97,456.36,42]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 45385",1,3040,1223.56,420.34,2929.62,760]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 80053",1,271,10.56,9.31,456.36,67.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - 72148",1,4633,275.13,254.07,3938.05,1158.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 73721",1,5064,275.13,254.07,4304.3999999999996,1266]
["TUFTS - TUFTS SPIRIT - CPT - 72110",1,595,123.44,46.45,595,148.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 45380",1,2575,420.34,420.34,2575,643.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 90832",1,168,179.02,21.97,456.36,42]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 80069",1,195,10.38,7.66,456.36,48.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 85027",1,45,7.73,5.71,456.36,11.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 80076",1,163,65.2,7.21,456.36,40.75]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - A9555",1,1385,554,420.34,1385,346.25]
["WELLCARE - WELLCARE HMO - CPT - 77066",1,924,131.5,131.5,924,231]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - Q9958",1,1,420.34,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 45380",1,2575,1834.71,420.34,2575,643.75]
["TUFTS - TUFTS CARELINK - CPT - 90853",1,129,18.329999999999998,15.63,456.36,32.25]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 90832",1,168,117.6,21.97,456.36,42]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 80069",1,195,12.02,7.66,456.36,48.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO STANDARD - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 90847",1,363,247.88,30.9,456.36,90.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["MEDICARE - MEDICARE PART A ONLY - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 19120",1,4199,420.34,420.34,6229.57,1049.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 72148",1,4633,420.34,254.07,3938.05,1158.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 77067",1,488,420.34,108.47,488,122]
["TUFTS - TUFTS HMO - CPT - 80076",1,163,163,7.21,456.36,40.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 90662",1,129,420.34,36.119999999999997,456.36,32.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 93452",1,6358,420.34,420.34,6358,1589.5]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 43239",1,1712,939.89,420.34,1871.88,428]
["UBH HPHC - UBH HPHC - CPT - 72110",1,595,123.44,46.45,595,148.75]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 45391",1,2924,1223.56,420.34,2924,731]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 72148",1,4633,275.13,254.07,3938.05,1158.25]
["TUFTS - TUFTS HMO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["TUFTS - TUFTS POS - CPT - 29881",1,5454,5454,420.34,5454,1363.5]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 90662",1,129,36.119999999999997,36.119999999999997,456.36,32.25]
["UNICARE - UNICARE STANDARD - CPT - 90662",1,129,76.180000000000007,36.119999999999997,456.36,32.25]
["TUFTS - TUFTS POS - CPT - 72148",1,4633,724.11,254.07,3938.05,1158.25]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["UNITED - UNITED DEFINITY HRA - CPT - 72193",1,3040,456.13,190.5,2584,760]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 62323",1,1485,776.47,420.34,1505.24,371.25]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 73721",1,5064,275.13,254.07,4304.3999999999996,1266]
["UNITED - UNITED DEFINITY HRA - CPT - J1030",1,13,13,4.68,456.36,3.25]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 84443",1,114,20.239999999999998,14.82,456.36,28.5]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 90715",1,180,180,39.75,456.36,45]
["UNITED - UNITED HP SHIP - CPT - 90715",1,180,180,39.75,456.36,45]
["UNITED - UNITED HP SHIP - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 43235",1,1505,1871.88,420.34,1871.88,376.25]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 43239",1,1712,1017.81,420.34,1871.88,428]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 66821",1,2811,652.66,420.34,2389.35,702.75]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 97110",1,249,145.28,23.1,456.36,62.25]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 80055",1,260,47.81,18.32,456.36,65]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["UNITED - UNITED NAVIGATE - CPT - 80048",1,167,7.61,7.46,456.36,41.75]
["UNITED - UNITED NAVIGATE - CPT - 90715",1,180,180,39.75,456.36,45]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - A9517",1,523,21.34,20.12,456.36,130.75]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - P9047",1,180,53.08,50.13,456.36,45]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["UNITED - UNITED PASSPORT CONNECT - CPT - 84443",1,114,51,14.82,456.36,28.5]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 29881",1,5454,611.83000000000004,420.34,5454,1363.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 80069",1,195,8.68,7.66,456.36,48.75]
["UNITED - UNITED STANDARD - CPT - 64483",1,1545,1545,420.34,1879.97,386.25]
["UNITED - UNITED STANDARD - CPT - 80055",1,260,43.03,18.32,456.36,65]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 62323",1,1485,717.03,420.34,1505.24,371.25]
["UNITED - UNITED STANDARD - CPT - A9513",1,429,429,154.44,456.36,107.25]
["TUFTS - TUFTS PPO - CPT - P9047",1,180,57.24,50.13,456.36,45]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 77067",1,488,108.47,108.47,488,122]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 85027",1,45,6.47,5.71,456.36,11.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 77065",1,752,102.59,102.59,752,188]
["MEDICARE - MEDICARE PART B ONLY - CPT - A9513",1,429,290.44,154.44,456.36,107.25]
["TUFTS - TUFTS SELECT - CPT - 74177",1,3263,458.44,398.75,2773.55,815.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 90846",1,308,179.02,30.9,456.36,77]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - A9575",1,8,8,0.13,456.36,2]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 85025",1,55,9.36,6.85,456.36,13.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 43239",1,1712,1017.81,420.34,1871.88,428]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 72148",1,4633,275.13,254.07,3938.05,1158.25]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - J1030",1,13,13,4.68,456.36,3.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 90662",1,129,36.119999999999997,36.119999999999997,456.36,32.25]
["TUFTS - TUFTS SELECT - CPT - A9575",1,8,8,0.13,456.36,2]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 95810",1,3935,1173.94,420.34,3344.75,983.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - A9581",1,99,99,15.3,456.36,24.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - J3301",1,18,18,0.98,456.36,4.5]
["TUFTS TOGETHER ACO - TUFTS TOGETHER ACO CHA - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["TUFTS TOGETHER ACO - TUFTS TOGETHER ACO UMASS MEMORIAL - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - A9517",1,523,21.34,20.12,456.36,130.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 85025",1,55,7.77,6.85,456.36,13.75]
["TUFTS - TUFTS SPIRIT - CPT - 85027",1,45,6.47,5.71,456.36,11.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH - CPT - 81001",1,24,2.8,2.8,456.36,6]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 70450",1,2022,123.44,113.99,1718.7,505.5]
["TUFTS - TUFTS CARELINK - CPT - 70450",1,2022,352.8,113.99,1718.7,505.5]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["TUFTS - TUFTS SPIRIT - CPT - A9581",1,99,99,15.3,456.36,24.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 77066",1,924,369.6,131.5,924,231]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 90662",1,129,51.6,36.119999999999997,456.36,32.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH CARE PLUS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["TUFTS - TUFTS CARELINK - CPT - 80061",1,129,36.619999999999997,11.81,456.36,32.25]
["WELLCARE - WELLCARE HMO - CPT - 72110",1,595,128.38,46.45,595,148.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH FAM ASSIST - CPT - 81001",1,24,2.8,2.8,456.36,6]
["WELLCARE - WELLCARE HMO - CPT - 97110",1,249,33.39,23.1,456.36,62.25]
["MEDICARE - MEDICARE PART B ONLY - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["WELLCARE - WELLCARE PPO - CPT - 64483",1,1545,1064.3499999999999,420.34,1879.97,386.25]
["WELLCARE - WELLCARE PPO - CPT - 80055",1,260,49.72,18.32,456.36,65]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["FALLON - FALLON PPO STANDARD - CPT - 90686",1,74,37,19.16,456.36,18.5]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 93452",1,6358,456.36,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 72193",1,3040,216.61,190.5,2584,760]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["FALLON HEALTHCRE ACO - FALLON HEALTHCARE ACO ATRIUS - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["HSN DENTAL - HSN DENTAL - CPT - 45385",1,3040,456.36,420.34,2929.62,760]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO BRKSHRE - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO RELIANT - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["MEDICAID - MEDICAID CARE PLUS - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 CARE PLUS - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 CARE PLUS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["HSN DENTAL - HSN DENTAL - CPT - 99385",1,530,456.36,23.27,530,132.5]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 80069",1,195,456.36,7.66,456.36,48.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 STANDARD - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 90846",1,308,187.97,30.9,456.36,77]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGH HLTHPLAN MCD MNG CMA - CPT - 81001",1,24,2.8,2.8,456.36,6]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE CAREPLUS - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["FALLON - FALLON HMO STANDARD - CPT - 29881",1,5454,2727,420.34,5454,1363.5]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["FALLON - FALLON POS STANDARD - CPT - 90846",1,308,154,30.9,456.36,77]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["HSN DENTAL - HSN DENTAL - CPT - 77067",1,488,456.36,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE COMMHLTH - CPT - 80055",1,260,42.17,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 72148",1,4633,2609.31,254.07,3938.05,1158.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 62323",1,1485,836.35,420.34,1505.24,371.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 90853",1,129,72.650000000000006,15.63,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 72193",1,3040,206.3,190.5,2584,760]
["MEDICAID ACO - MEDICAID ACO STEWRD FAM ASSIS - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["MEDICAID ACO - ZZZMEDICAID ACO COMM STANDARD - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 90686",1,74,20.72,19.16,456.36,18.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 95810",1,3935,1173.94,420.34,3344.75,983.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["MEDICARE - MEDICARE A&B - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 77067",1,488,108.47,108.47,488,122]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 64483",1,1545,1023.42,420.34,1879.97,386.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 84153",1,125,18.39,13.26,456.36,31.25]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 90834",1,215,456.36,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["HSN DENTAL - HSN DENTAL - CPT - 85027",1,45,456.36,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 45380",1,2575,1391.24,420.34,2575,643.75]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - A9513",1,429,456.36,154.44,456.36,107.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 80061",1,129,13.39,11.81,456.36,32.25]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 64483",1,1545,1023.42,420.34,1879.97,386.25]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 90834",1,215,179.02,27.84,456.36,53.75]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 62323",1,1485,836.35,420.34,1505.24,371.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 77066",1,924,131.5,131.5,924,231]
["FALLON SCO - FALLON SCO HMO - CPT - 45385",1,3040,1324.99,420.34,2929.62,760]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - A9581",1,99,55.76,15.3,456.36,24.75]
["FALLON SCO - FALLON SCO HMO - CPT - 80076",1,163,8.17,7.21,456.36,40.75]
["FALLON - FALLON COMMUNITY PLAN - CPT - 73721",1,5064,2532,254.07,4304.3999999999996,1266]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["FALLON - FALLON COMMUNITY PLAN - CPT - 90832",1,168,84,21.97,456.36,42]
["FALLON SCO - FALLON SCO HMO - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - CPT - 85027",1,45,6.57,5.71,456.36,11.25]
["FALLON - FALLON HMO STANDARD - CPT - 43235",1,1505,752.5,420.34,1871.88,376.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 77066",1,924,924,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 77067",1,488,108.47,108.47,488,122]
["MEDICAID - MEDICAID CORRECTIONS IP - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 90853",1,129,64.89,15.63,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["FALLON - FALLON HMO STANDARD - CPT - Q9966",1,1,0.5,0.36,456.36,0.25]
["MEDICAID ACO - ZZZMEDICAID ACO COMM FAM ASSIST - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 72110",1,595,595,46.45,595,148.75]
["FALLON - FALLON POS STANDARD - CPT - 80069",1,195,97.5,7.66,456.36,48.75]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD COMMONHLT - CPT - 80055",1,260,42.17,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 90853",1,129,64.89,15.63,456.36,32.25]
["MEDICAID MANAGED CARE - MCD MNG CARE ESSENTIAL - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["MEDICAID MANAGED CARE - MCD MNG CARE STANDARD - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["MEDICARE - MEDICARE A&B - CPT - 81001",1,24,3.17,2.8,456.36,6]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 45391",1,2924,2408.3200000000002,420.34,2924,731]
["MEDICARE - MEDICARE PART A ONLY - CPT - 77066",1,924,131.5,131.5,924,231]
["HSN - HSN TEMPORARY - CPT - 85027",1,45,456.36,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 77066",1,924,131.5,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 80055",1,260,50.2,18.32,456.36,65]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 66984",1,2224,456.36,420.34,4241.13,556]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 81001",1,24,3.33,2.8,456.36,6]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 45391",1,2924,2408.3200000000002,420.34,2924,731]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - J1030",1,13,13,4.68,456.36,3.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 77065",1,752,752,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 90846",1,308,187.97,30.9,456.36,77]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - P9047",1,180,456.36,50.13,456.36,45]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 90847",1,363,182.59,30.9,456.36,90.75]
["HSN DENTAL - HSN DENTAL - CPT - 66984",1,2224,456.36,420.34,4241.13,556]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 66984",1,2224,2747.38,420.34,4241.13,556]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 90832",1,168,187.97,21.97,456.36,42]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 77065",1,752,752,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - P9047",1,180,55.73,50.13,456.36,45]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - P9047",1,180,456.36,50.13,456.36,45]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 90847",1,363,182.59,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 90834",1,215,456.36,27.84,456.36,53.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 43235",1,1505,1871.88,420.34,1871.88,376.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 66984",1,2224,2747.38,420.34,4241.13,556]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 77065",1,752,752,102.59,752,188]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 90847",1,363,182.59,30.9,456.36,90.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 90846",1,308,173.47,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 72193",1,3040,216.61,190.5,2584,760]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 80076",1,163,22.32,7.21,456.36,40.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["FALLON - FALLON COMMUNITY PLAN - CPT - 29881",1,5454,2727,420.34,5454,1363.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 45385",1,3040,2408.3200000000002,420.34,2929.62,760]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - A9575",1,8,4.51,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 80076",1,163,22.32,7.21,456.36,40.75]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGH HLTHPLAN MCD MNG CMA - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - J3301",1,18,18,0.98,456.36,4.5]
["FALLON - FALLON COMMUNITY PLAN - CPT - 93452",1,6358,3179,420.34,6358,1589.5]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1 - CPT - 80048",1,167,8.58,7.46,456.36,41.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 45380",1,2575,2408.3200000000002,420.34,2575,643.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 2 - CPT - 80069",1,195,8.81,7.66,456.36,48.75]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["FALLON - FALLON HMO STANDARD - CPT - 19120",1,4199,2099.5,420.34,6229.57,1049.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 80076",1,163,22.32,7.21,456.36,40.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 85027",1,45,25.34,5.71,456.36,11.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 90846",1,308,154.91999999999999,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["MEDICAID - CMSP STANDARD - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["FALLON - FALLON HMO STANDARD - CPT - 77067",1,488,244,108.47,488,122]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 45380",1,2575,2408.3200000000002,420.34,2575,643.75]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 72193",1,3040,395.2,190.5,2584,760]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 80055",1,260,50.2,18.32,456.36,65]
["MEDICAID - MEDICAID SENIOR BUY-IN - CPT - 80076",1,163,7.21,7.21,456.36,40.75]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 85027",1,45,17.649999999999999,5.71,456.36,11.25]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 90846",1,308,154.91999999999999,30.9,456.36,77]
["FALLON - FALLON HMO STANDARD - CPT - A9500",1,357,178.5,128.52000000000001,456.36,89.25]
["MEDICAID ACO - MEDICAID ACO STEWRD - CPT - 84443",1,114,14.82,14.82,456.36,28.5]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["FALLON - FALLON POS STANDARD - CPT - 45380",1,2575,1287.5,420.34,2575,643.75]
["MEDICAID ACO - ZZZMEDICAID ACO COMM STANDARD - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 77065",1,752,102.59,102.59,752,188]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG FAM ASSIS - CPT - 80076",1,163,7.21,7.21,456.36,40.75]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - CPT - 81001",1,24,2.8,2.8,456.36,6]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["FALLON - FALLON POS STANDARD - CPT - 90715",1,180,90,39.75,456.36,45]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD FAM ASSIS - CPT - 84443",1,114,14.82,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["HSN - HSN STANDARD - CPT - 72148",1,4633,456.36,254.07,3938.05,1158.25]
["MEDICAID MANAGED CARE - MCD MNG CARE ESSENTIAL - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["MEDICAID MANAGED CARE - MCD MNG CARE FAMILY ASSIST - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["HSN - HSN STANDARD - CPT - 90662",1,129,456.36,36.119999999999997,456.36,32.25]
["MEDICARE - MEDICARE A&B - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["HSN - HSN STANDARD - CPT - A9575",1,8,456.36,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 72193",1,3040,216.61,190.5,2584,760]
["MEDICARE - MEDICARE A&B - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["MEDICARE - MEDICARE PART A ONLY - CPT - 72110",1,595,123.44,46.45,595,148.75]
["MEDICARE - MEDICARE PART A ONLY - CPT - 81001",1,24,3.17,2.8,456.36,6]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 72110",1,595,123.44,46.45,595,148.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 77066",1,924,131.5,131.5,924,231]
["AETNA - AETNA HMO - CPT - 90837",1,215,113.74,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 90853",1,129,100.08,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 84153",1,125,18.39,13.26,456.36,31.25]
["AETNA - AETNA MCR SUPP - CPT - 80055",1,260,137.54,18.32,456.36,65]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - J3301",1,18,18,0.98,456.36,4.5]
["BCBS - BCBS POS - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 64483",1,1545,1074.5899999999999,420.34,1879.97,386.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 72193",1,3040,502.46,190.5,2584,760]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 90686",1,74,22.35,19.16,456.36,18.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["BCBS - BCBS POS - CPT - 90662",1,129,73.400000000000006,36.119999999999997,456.36,32.25]
["AETNA - AETNA MCR SUPP - CPT - 90853",1,129,68.239999999999995,15.63,456.36,32.25]
["BCBS - BCBS STANDARD - CPT - 73721",1,5064,574.25,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90834",1,215,179.02,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - 99385",1,530,280.37,23.27,530,132.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 90686",1,74,22.35,19.16,456.36,18.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["AETNA - AETNA MCR SUPP - CPT - J1030",1,13,6.88,4.68,456.36,3.25]
["AETNA - AETNA MCR SUPP - CPT - J3301",1,18,9.52,0.98,456.36,4.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 77066",1,924,131.5,131.5,924,231]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 77067",1,488,177.13,108.47,488,122]
["AETNA - AETNA POS - CPT - 45380",1,2575,1362.18,420.34,2575,643.75]
["BCBS - BCBS PPO - CPT - 90853",1,129,140.56,15.63,456.36,32.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 93452",1,6358,5171.1000000000004,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85025",1,55,7.77,6.85,456.36,13.75]
["AETNA - AETNA HMO - CPT - 77065",1,752,397.81,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 72148",1,4633,574.25,254.07,3938.05,1158.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 77067",1,488,177.13,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 90715",1,180,180,39.75,456.36,45]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 90662",1,129,73.400000000000006,36.119999999999997,456.36,32.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 93452",1,6358,5171.1000000000004,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 77067",1,488,108.47,108.47,488,122]
["AETNA - AETNA HMO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["AETNA - AETNA POS - CPT - 85027",1,45,23.81,5.71,456.36,11.25]
["CCA - CCA SCO ONECARE - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["CCA - CCA SCO ONECARE - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 80069",1,195,9.5500000000000007,7.66,456.36,48.75]
["CCA - CCA SCO ONECARE - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CCA - CCA SCO ONECARE - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CCA - CCA SCO ONECARE - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["BCBS - BCBS INDEMNITY - CPT - 90846",1,308,234.69,30.9,456.36,77]
["CCA - CCA SCO ONECARE - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CCA - CCA SCO STANDARD - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["BCBS - BCBS POS - CPT - 45380",1,2575,1802.8,420.34,2575,643.75]
["AETNA - AETNA POS - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 90846",1,308,187.97,30.9,456.36,77]
["CCA - CCA SCO STANDARD - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CCA - CCA SCO STANDARD - CPT - 90846",1,308,187.97,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90832",1,168,179.02,21.97,456.36,42]
["CCA - CCA SCO STANDARD - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CCA - CCA SCO STANDARD - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["BCBS - BCBS PPO - CPT - A9575",1,8,8,0.13,456.36,2]
["CCA - ZZZCCA STANDARD - CPT - 80055",1,260,50.2,18.32,456.36,65]
["AETNA - AETNA PPO EPO - CPT - 66984",1,2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA PPO EPO - CPT - 72148",1,4633,2450.86,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72193",1,3040,206.3,190.5,2584,760]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["CCA - ZZZCCA STANDARD - CPT - J1030",1,13,13,4.68,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80053",1,271,10.56,9.31,456.36,67.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 45391",1,2924,1802.8,420.34,2924,731]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 72193",1,3040,502.46,190.5,2584,760]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 77067",1,488,108.47,108.47,488,122]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["AETNA - AETNA HMO - CPT - A9517",1,523,276.67,20.12,456.36,130.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["AETNA - AETNA PPO EPO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["AETNA - AETNA PPO EPO - CPT - P9047",1,180,95.22,50.13,456.36,45]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 72193",1,3040,216.61,190.5,2584,760]
["AETNA - AETNA MCR SUPP - CPT - 62323",1,1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 29881",1,5454,2885.17,420.34,5454,1363.5]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 62323",1,1485,854.12,420.34,1505.24,371.25]
["BCBS - BCBS INDEMNITY - CPT - 66821",1,2811,912.96,420.34,2389.35,702.75]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["CIGNA - CIGNA CARELINK - CPT - 66984",1,2224,3587.95,420.34,4241.13,556]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["BCBS - BCBS INDEMNITY - CPT - 84153",1,125,36.090000000000003,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - P9047",1,180,55.73,50.13,456.36,45]
["CIGNA - CIGNA CARELINK - CPT - 90846",1,308,36.229999999999997,30.9,456.36,77]
["AETNA - AETNA STUDENT HEALTH - CPT - 80061",1,129,68.239999999999995,11.81,456.36,32.25]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - J1030",1,13,13,4.68,456.36,3.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 84443",1,114,60.31,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["CIGNA - CIGNA LOCALPLUS - CPT - 80061",1,129,14.81,11.81,456.36,32.25]
["CIGNA - CIGNA LOCALPLUS - CPT - 85025",1,55,8.59,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 84153",1,125,18.39,13.26,456.36,31.25]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["BCBS - BCBS POS - CPT - 80048",1,167,16.61,7.46,456.36,41.75]
["CIGNA - CIGNA LOCALPLUS - CPT - P9047",1,180,153,50.13,456.36,45]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["BCBS - BCBS POS - CPT - 85027",1,45,12.6,5.71,456.36,11.25]
["AETNA - AETNA STUDENT HEALTH - CPT - A9500",1,357,188.85,128.52000000000001,456.36,89.25]
["CIGNA - CIGNA STANDARD - CPT - 80061",1,129,14.81,11.81,456.36,32.25]
["BCBS - BCBS POS - CPT - A9517",1,523,88.64,20.12,456.36,130.75]
["CIGNA - CIGNA STANDARD - CPT - 90834",1,215,182.75,27.84,456.36,53.75]
["CIGNA - CIGNA STANDARD - CPT - 95810",1,3935,3344.75,420.34,3344.75,983.75]
["CIGNA - CIGNA STANDARD - CPT - A9513",1,429,364.65,154.44,456.36,107.25]
["CIGNA - CIGNA STANDARD - CPT - P9047",1,180,153,50.13,456.36,45]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 77066",1,924,131.5,131.5,924,231]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 66821",1,2811,685.29,420.34,2389.35,702.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45391",1,2924,1324.99,420.34,2924,731]
["BCBS - BCBS PPO - CPT - P9047",1,180,53.08,50.13,456.36,45]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 90846",1,308,187.97,30.9,456.36,77]
["BCBS - BCBS SHIP PPO - CPT - 90834",1,215,234.69,27.84,456.36,53.75]
["BCBS - BCBS SHIP PPO - CPT - A9513",1,429,318.61,154.44,456.36,107.25]
["BCBS - BCBS SHIP PPO - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - A9581",1,99,99,15.3,456.36,24.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 80076",1,163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 97110",1,249,32.11,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - J3301",1,18,18,0.98,456.36,4.5]
["BCBS - BCBS STANDARD - CPT - 85025",1,55,15.47,6.85,456.36,13.75]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 64483",1,1545,1074.5899999999999,420.34,1879.97,386.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - P9047",1,180,53.08,50.13,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["BCBS - BCBS HMO - CPT - 43235",1,1505,1401.24,420.34,1871.88,376.25]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 80069",1,195,17.18,7.66,456.36,48.75]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80048",1,167,8.4600000000000009,7.46,456.36,41.75]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["AETNA - AETNA HMO - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 73721",1,5064,275.13,254.07,4304.3999999999996,1266]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 72193",1,3040,216.61,190.5,2584,760]
["AETNA - AETNA HMO - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["AETNA - AETNA HMO - CPT - J3301",1,18,9.52,0.98,456.36,4.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 77066",1,924,131.5,131.5,924,231]
["BCBS - BCBS HMO - CPT - 85027",1,45,12.6,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 19120",1,4199,4279.8500000000004,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 77065",1,752,102.59,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 77066",1,924,131.5,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 77067",1,488,108.47,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 80055",1,260,47.81,18.32,456.36,65]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80069",1,195,9.11,7.66,456.36,48.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 80061",1,129,13.39,11.81,456.36,32.25]
["BCBS - BCBS HMO - CPT - 90662",1,129,73.400000000000006,36.119999999999997,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 66821",1,2811,685.29,420.34,2389.35,702.75]
["BCBS - BCBS HMO - CPT - 90686",1,74,22.35,19.16,456.36,18.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["BCBS - BCBS HMO - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 72193",1,3040,216.61,190.5,2584,760]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 81001",1,24,3.17,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 77065",1,752,102.59,102.59,752,188]
["BCBS - BCBS HMO - CPT - 90832",1,168,234.69,21.97,456.36,42]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 77067",1,488,108.47,108.47,488,122]
["BCBS - BCBS HMO - CPT - 90834",1,215,234.69,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90846",1,308,187.97,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 85027",1,45,6.47,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["BCBS - BCBS HMO - CPT - 90837",1,215,234.69,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["BCBS - BCBS HMO - CPT - 90846",1,308,234.69,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["BCBS - BCBS HMO - CPT - 90847",1,363,234.69,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80061",1,129,13.39,11.81,456.36,32.25]
["BCBS - BCBS HMO - CPT - 90853",1,129,140.56,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90686",1,74,20.72,19.16,456.36,18.5]
["BCBS - BCBS HMO - CPT - 93452",1,6358,5171.1000000000004,420.34,6358,1589.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90832",1,168,179.02,21.97,456.36,42]
["BCBS - BCBS HMO - CPT - 95810",1,3935,1679.52,420.34,3344.75,983.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["BCBS - BCBS HMO - CPT - 97110",1,249,83.91,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90837",1,215,179.02,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - J1030",1,13,13,4.68,456.36,3.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - P9047",1,180,55.73,50.13,456.36,45]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90846",1,308,179.02,30.9,456.36,77]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9575",1,8,8,0.13,456.36,2]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43235",1,1505,1017.81,420.34,1871.88,376.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - J1030",1,13,13,4.68,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 45380",1,2575,1391.24,420.34,2575,643.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - P9047",1,180,55.73,50.13,456.36,45]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 95810",1,3935,1173.94,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 64483",1,1545,1074.5899999999999,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43239",1,1712,1017.81,420.34,1871.88,428]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 66984",1,2224,2747.38,420.34,4241.13,556]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 97110",1,249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["AETNA - AETNA MCR SUPP - CPT - 19120",1,4199,2221.27,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["AETNA - AETNA MCR SUPP - CPT - 43235",1,1505,796.15,420.34,1871.88,376.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 77066",1,924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 45380",1,2575,1391.24,420.34,2575,643.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 80069",1,195,9.11,7.66,456.36,48.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["AETNA - AETNA MCR SUPP - CPT - 43239",1,1712,905.65,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45385",1,3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81001",1,24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45391",1,2924,1324.99,420.34,2924,731]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 64483",1,1545,1074.5899999999999,420.34,1879.97,386.25]
["AETNA - AETNA MCR SUPP - CPT - 45385",1,3040,1608.16,420.34,2929.62,760]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 66821",1,2811,685.29,420.34,2389.35,702.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 66984",1,2224,2747.38,420.34,4241.13,556]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90846",1,308,187.97,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 74177",1,3263,431.8,398.75,2773.55,815.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9513",1,429,290.44,154.44,456.36,107.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 72193",1,3040,216.61,190.5,2584,760]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9581",1,99,99,15.3,456.36,24.75]
["BCBS - BCBS HMO - CPT - 99385",1,530,342.38,23.27,530,132.5]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["BCBS - BCBS HMO - CPT - 99386",1,640,413.44,23.27,640,160]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["BCBS - BCBS HMO - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 77065",1,752,102.59,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 77066",1,924,131.5,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 77067",1,488,108.47,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80069",1,195,9.11,7.66,456.36,48.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80069",1,195,8.68,7.66,456.36,48.75]
["BCBS - BCBS HMO - CPT - A9513",1,429,318.61,154.44,456.36,107.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 66821",1,2811,685.29,420.34,2389.35,702.75]
["BCBS - BCBS HMO - CPT - A9517",1,523,88.64,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["BCBS - BCBS HMO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 72193",1,3040,216.61,190.5,2584,760]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 77065",1,752,102.59,102.59,752,188]
["BCBS - BCBS HMO - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 77067",1,488,108.47,108.47,488,122]
["BCBS - BCBS HMO - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90846",1,308,187.97,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 45391",1,2924,1324.99,420.34,2924,731]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["BCBS - BCBS HMO - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["BCBS - BCBS HMO - CPT - J1030",1,13,9.33,4.68,456.36,3.25]
["AETNA - AETNA MCR SUPP - CPT - 66821",1,2811,1487.02,420.34,2389.35,702.75]
["BCBS - BCBS HMO - CPT - J3301",1,18,18,0.98,456.36,4.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 64483",1,1545,1023.42,420.34,1879.97,386.25]
["BCBS - BCBS HMO - CPT - P9047",1,180,53.08,50.13,456.36,45]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 66984",1,2224,2616.5500000000002,420.34,4241.13,556]
["BCBS - BCBS HMO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62323",1,1485,776.47,420.34,1505.24,371.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CIGNA - CIGNA CARELINK - CPT - 84153",1,125,50.31,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CIGNA - CIGNA CARELINK - CPT - 84443",1,114,45.94,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CIGNA - CIGNA CARELINK - CPT - 85025",1,55,21.26,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 19120",1,4199,4279.8500000000004,420.34,6229.57,1049.75]
["CIGNA - CIGNA CARELINK - CPT - 85027",1,45,17.690000000000001,5.71,456.36,11.25]
["Grand Total",25513,926.82185552463454,388.55211421628593,0.09,6358,231.70546388115864]

{"sheet":"CPT Pivot data","index":13,"n_rows":18351,"n_cols":7,"rows_kept":2250,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
["Payer - Plan - Bill Type - Bill Code","Sum of Duplicates","Average of Gross Charge Amount","Average of Payer Charge Amount","Min of Minimum Charge Amount","Max of Maximum Charge Amount","Average of Self-Pay Charge"]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - Q9967",18,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - Q9967",18,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZAETNA - ZZZAETNA POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - Q9967",9,1.2222222222222223,1.0388888888888888,0.12,456.36,0.30555555555555558]
["WELLCARE - WELLCARE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WELLCARE - WELLCARE STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - Q9967",9,1.2222222222222223,0.43999999999999989,0.12,456.36,0.30555555555555558]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - Q9967",9,1.2222222222222223,0.52333333333333343,0.12,456.36,0.30555555555555558]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZAETNA - ZZZAETNA HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - Q9967",9,1.2222222222222223,0.52333333333333343,0.12,456.36,0.30555555555555558]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - Q9967",9,1.2222222222222223,0.64777777777777801,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - Q9967",9,1.2222222222222223,1.0388888888888888,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP MBTA - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - Q9967",9,1.2222222222222223,0.52333333333333343,0.12,456.36,0.30555555555555558]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - Q9967",9,1.2222222222222223,0.52333333333333343,0.12,456.36,0.30555555555555558]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - Q9967",9,1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED - UNITED HP SHIP - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MEDICARE - MEDICARE PART A ONLY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MEDICARE - MEDICARE PART B ONLY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED - UNITED STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WELLCARE - WELLCARE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNICARE - UNICARE STANDARD - CPT - Q9967",9,1.2222222222222223,0.12000000000000001,0.12,456.36,0.30555555555555558]
["TRICARE EAST - TRICARE EAST SELECT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED - UNITED NAVIGATE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS CARELINK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS SELECT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS SPIRIT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["UBH HPHC - UBH HPHC - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["UNITED - UNITED DEFINITY HRA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["UNITED - UNITED HP STUDENT HEALTH - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED - UNITED PASSPORT CONNECT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - Q9967",9,1.2222222222222223,0.48888888888888882,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - Q9967",9,1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MEDICARE - MEDICARE A&B - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HSN DENTAL - HSN DENTAL - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HSN - HSN STANDARD - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - Q9967",9,1.2222222222222223,0.68666666666666687,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HSN BAD DEBT - HSN BAD DEBT - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - Q9967",9,1.2222222222222223,0.68666666666666687,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["FALLON - FALLON COMMUNITY PLAN - CPT - Q9967",9,1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["HSN - HSN TEMPORARY - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["FALLON - FALLON HMO STANDARD - CPT - Q9967",9,1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["FALLON - FALLON POS STANDARD - CPT - Q9967",9,1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - Q9967",9,1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["FALLON - FALLON PPO STANDARD - CPT - Q9967",9,1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - Q9967",9,1.2222222222222223,0.68666666666666687,0.12,456.36,0.30555555555555558]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - Q9967",9,1.2222222222222223,0.68666666666666676,0.12,456.36,0.30555555555555558]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["FALLON SCO - FALLON SCO HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CIGNA - CIGNA LOCALPLUS - CPT - Q9967",9,1.2222222222222223,1.0388888888888888,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967",9,1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS INDEMNITY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CIGNA - CIGNA CARELINK - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS SHIP PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CIGNA - CIGNA STANDARD - CPT - Q9967",9,1.2222222222222223,1.0388888888888888,0.12,456.36,0.30555555555555558]
["BCBS - BCBS STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA - CCA SCO ONECARE - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA - CCA SCO STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA - ZZZCCA STANDARD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - Q9967",9,1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - Q9967",8,1.25,1.25,0.12,456.36,0.3125]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - Q9967",8,1.25,1.25,0.12,456.36,0.3125]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 45378",6,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 45378",6,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 55700",4,2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 85610",4,29,4.5,3.58,456.36,7.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 76830",4,1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 62322",4,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99205",4,899,173.23000000000002,23.27,899,224.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99215",4,595,153.80000000000001,23.27,595,148.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 62322",4,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 70553",4,6917,453.39,398.75,5879.45,1729.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 76700",4,1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 76700",4,1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 81002",4,17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 76805",4,1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99203",4,415,120.89000000000001,23.27,456.36,103.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 76830",4,1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99213",4,277,112.53999999999999,23.27,456.36,69.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81000",4,24,4.22,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - Q9963",4,1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81002",4,17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 55700",4,2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81003",4,17,2.36,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 70553",4,6917,453.39,398.75,5879.45,1729.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 85610",4,29,4.5,3.58,456.36,7.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 76805",4,1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 85730",4,42,6.31,5.3,456.36,10.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 81000",4,24,4.22,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99203",4,415,120.89,23.27,456.36,103.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 81003",4,17,2.36,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99204",4,705,147.94,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 85730",4,42,6.31,5.3,456.36,10.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99205",4,899,173.23000000000002,23.27,899,224.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99204",4,705,147.94,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99212",4,147,96.429999999999993,23.27,456.36,36.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99212",4,147,96.429999999999993,23.27,456.36,36.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99213",4,277,112.53999999999999,23.27,456.36,69.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99214",4,422,128.995,23.27,456.36,105.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99215",4,595,153.80000000000001,23.27,595,148.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - A9579",4,4,4,1.08,456.36,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - A9579",4,4,4,1.08,456.36,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - Q9963",4,1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99214",4,422,128.995,23.27,456.36,105.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 45378",3,2154,1830.9000000000003,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA POS - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 45378",3,2154,1139.47,395.43,2154,538.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["WELLCARE - WELLCARE STANDARD - CPT - 45378",3,2154,1067.25,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 45378",3,2154,775.44,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 45378",3,2154,1830.9000000000003,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 45378",3,2154,395.43,395.43,2154,538.5]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 45378",3,2154,947.64,395.43,2154,538.5]
["TUFTS - TUFTS POS - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 45378",3,2154,1231.44,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["TUFTS - TUFTS PPO - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["MEDICARE - MEDICARE PART B ONLY - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["WELLCARE - WELLCARE HMO - CPT - 45378",3,2154,1067.25,395.43,2154,538.5]
["TUFTS - TUFTS CARELINK - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["TUFTS - TUFTS SELECT - CPT - 45378",3,2154,736.24000000000012,395.43,2154,538.5]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS - TUFTS HMO - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 45378",3,2154,1231.44,395.43,2154,538.5]
["UNITED - UNITED HP SHIP - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["TUFTS - TUFTS SPIRIT - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED - UNITED NAVIGATE - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED - UNITED PASSPORT CONNECT - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["UNITED - UNITED STANDARD - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 45378",3,2154,947.64,395.43,2154,538.5]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 45378",3,2154,947.64,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UBH HPHC - UBH HPHC - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 45378",3,2154,420.34,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNICARE - UNICARE STANDARD - CPT - 45378",3,2154,1020.59,395.43,2154,538.5]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 45378",3,2154,861.6,395.43,2154,538.5]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["UNITED - UNITED DEFINITY HRA - CPT - 45378",3,2154,2154,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 45378",3,2154,1420.9800000000002,395.43,2154,538.5]
["WELLCARE - WELLCARE PPO - CPT - 45378",3,2154,1067.25,395.43,2154,538.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["FALLON - FALLON PPO STANDARD - CPT - 45378",3,2154,1077,395.43,2154,538.5]
["FALLON SCO - FALLON SCO HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["MEDICARE - MEDICARE PART A ONLY - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["FALLON - FALLON COMMUNITY PLAN - CPT - 45378",3,2154,1077,395.43,2154,538.5]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["HSN DENTAL - HSN DENTAL - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["FALLON - FALLON HMO STANDARD - CPT - 45378",3,2154,1077,395.43,2154,538.5]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 45378",3,2154,1213.1300000000001,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 45378",3,2154,1213.1300000000001,395.43,2154,538.5]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 45378",3,2154,1213.1300000000001,395.43,2154,538.5]
["FALLON - FALLON POS STANDARD - CPT - 45378",3,2154,1077,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 45378",3,2154,1213.1300000000001,395.43,2154,538.5]
["HSN - HSN STANDARD - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["MEDICARE - MEDICARE A&B - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["HSN - HSN TEMPORARY - CPT - 45378",3,2154,456.35999999999996,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 45378",3,2154,1830.93,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA - AETNA HMO - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 45378",3,2154,1128.82,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CIGNA - CIGNA CARELINK - CPT - 45378",3,2154,1505.24,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BCBS INDEMNITY - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CCA - CCA SCO ONECARE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378",3,2154,1139.47,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["BCBS - BCBS HMO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CCA - CCA SCO STANDARD - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BCBS POS - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CCA - ZZZCCA STANDARD - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA - AETNA POS - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA MCR SUPP - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BCBS PPO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["AETNA - AETNA PPO EPO - CPT - 45378",3,2154,1592.25,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CIGNA - CIGNA LOCALPLUS - CPT - 45378",3,2154,1830.9000000000003,395.43,2154,538.5]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["BCBS - BCBS STANDARD - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["BCBS - BCBS SHIP PPO - CPT - 45378",3,2154,1370.57,395.43,2154,538.5]
["CIGNA - CIGNA STANDARD - CPT - 45378",3,2154,1830.9000000000003,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378",3,2154,1026.2,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 45378",3,2154,1128.82,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 45378",3,2154,1077.51,395.43,2154,538.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 81003",2,17,2.38,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99215",2,595,505.75,23.27,595,148.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 76830",2,1028,873.8,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99205",2,899,155.85,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 62322",2,1426,1212.0999999999999,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99203",2,415,27.28,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99215",2,595,595,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 76830",2,1028,272.94,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 85730",2,42,6.36,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY FAM ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO BI/LAHEY - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 99213",2,277,155.85,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 85610",2,29,4.34,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 76700",2,1131,353.57,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99205",2,899,764.15,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 99205",2,899,328.17,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99215",2,595,595,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76830",2,1028,272.94,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 81000",2,24,4.26,2.89,456.36,6]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 3 - CPT - 85610",2,29,4.54,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA POS - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 81002",2,17,3.68,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO FAM ASST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99215",2,595,155.85,23.27,595,148.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 99203",2,415,155.85,23.27,456.36,103.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 76830",2,1028,873.8,113.99,873.8,257]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99205",2,899,764.15,23.27,899,224.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO BI/LAHEY - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 81002",2,17,9.51,2.34,456.36,4.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99213",2,277,27.28,23.27,456.36,69.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 62322",2,1426,1212.0999999999999,82.95,1426,356.5]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 85610",2,29,4.34,3.58,456.36,7.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99215",2,595,505.75,23.27,595,148.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO COMM - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99215",2,595,595,23.27,595,148.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WELLCARE - WELLCARE PPO - CPT - 99215",2,595,154.36000000000001,23.27,595,148.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 55700",2,2348,845.28,420.34,3848.68,587]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 62322",2,1426,513.36,82.95,1426,356.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 70553",2,6917,2490.12,398.75,5879.45,1729.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 76700",2,1131,407.16,111.92,961.35,282.75]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 76805",2,1192,429.12,113.99,1013.2,298]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 76830",2,1028,370.08,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 81000",2,24,2.89,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 85610",2,29,3.86,3.58,456.36,7.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 81002",2,17,2.34,2.34,456.36,4.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 99215",2,595,328.17,23.27,595,148.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 81003",2,17,1.63,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 85610",2,29,3.58,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 85730",2,42,5.48,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99203",2,415,415,23.27,456.36,103.75]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99204",2,705,705,23.27,705,176.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SIG - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99212",2,147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99213",2,277,277,23.27,456.36,69.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99214",2,422,422,23.27,456.36,105.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 99215",2,595,595,23.27,595,148.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85610",2,29,3.86,3.58,456.36,7.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - A9579",2,4,1.44,1.08,456.36,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - Q9963",2,1,0.36,0.22,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLCARE - WELLCARE PPO - CPT - A9579",2,4,4,1.08,456.36,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLCARE - WELLCARE PPO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 1 - CPT - 85610",2,29,4.54,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 55700",2,2348,2286.9499999999998,420.34,3848.68,587]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 70553",2,6917,431.8,398.75,5879.45,1729.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 81000",2,24,4.0199999999999996,2.89,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 85730",2,42,6.01,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 81003",2,17,2.38,1.63,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 99203",2,415,100,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - A9579",2,4,4,1.08,456.36,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLCARE - WELLCARE PPO - CPT - 99212",2,147,154.36000000000001,23.27,456.36,36.75]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLCARE - WELLCARE PPO - CPT - 99213",2,277,154.36000000000001,23.27,456.36,69.25]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 3 - CPT - 81002",2,17,3.68,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 55700",2,2348,2286.9499999999998,420.34,3848.68,587]
["ZZZAETNA - ZZZAETNA HMO - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 70553",2,6917,431.8,398.75,5879.45,1729.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["ZZZAETNA - ZZZAETNA HMO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 81000",2,24,4.0199999999999996,2.89,456.36,6]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 85730",2,42,6.01,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 81000",2,24,4.26,2.89,456.36,6]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["ZZZAETNA - ZZZAETNA POS - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 62322",2,1426,754.35,82.95,1426,356.5]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 76830",2,1028,543.80999999999995,113.99,873.8,257]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - A9579",2,4,4,1.08,456.36,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 85610",2,29,15.34,3.58,456.36,7.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99205",2,899,475.57,23.27,899,224.75]
["WELLCARE - WELLCARE STANDARD - CPT - 55700",2,2348,2378.4299999999998,420.34,3848.68,587]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 99215",2,595,314.76,23.27,595,148.75]
["WELLCARE - WELLCARE STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 85730",2,42,6.36,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 76700",2,1131,598.29999999999995,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99203",2,415,219.54,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - Q9963",2,1,0.53,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 85730",2,42,8.3800000000000008,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 85610",2,29,4.54,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99203",2,415,100,23.27,456.36,103.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99204",2,705,150.71,23.27,705,176.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99205",2,899,188.86,23.27,899,224.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99203",2,415,155.85,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99212",2,147,41.58,23.27,456.36,36.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99213",2,277,155.85,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 99215",2,595,132.82,23.27,595,148.75]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - A9579",2,4,1.71,1.08,456.36,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 99205",2,899,155.85,23.27,899,224.75]
["WELLCARE - WELLCARE STANDARD - CPT - 70553",2,6917,449.08,398.75,5879.45,1729.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 99215",2,595,155.85,23.27,595,148.75]
["WELLCARE - WELLCARE STANDARD - CPT - 76700",2,1131,128.38,111.92,961.35,282.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO BI/LAHEY - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 76700",2,1131,961.35,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 81002",2,17,2.83,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99203",2,415,352.75,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99213",2,277,235.45,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - Q9963",2,1,0.85,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 76830",2,1028,352.8,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 85610",2,29,11.73,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99205",2,899,27.28,23.27,899,224.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99215",2,595,27.28,23.27,595,148.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 85730",2,42,8.3800000000000008,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99203",2,415,100,23.27,456.36,103.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 76700",2,1131,961.35,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99204",2,705,150.71,23.27,705,176.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 81002",2,17,2.83,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99205",2,899,188.86,23.27,899,224.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99203",2,415,352.75,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99212",2,147,41.58,23.27,456.36,36.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 99213",2,277,235.45,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - Q9963",2,1,0.85,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99215",2,595,132.82,23.27,595,148.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - A9579",2,4,1.71,1.08,456.36,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WELLCARE - WELLCARE STANDARD - CPT - 76805",2,1192,128.38,113.99,1013.2,298]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WELLCARE - WELLCARE STANDARD - CPT - 76830",2,1028,128.38,113.99,873.8,257]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO COMM - CPT - 81000",2,24,3.55,2.89,456.36,6]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 81002",2,17,3.48,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 99205",2,899,899,23.27,899,224.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 85610",2,29,5.49,3.58,456.36,7.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 99215",2,595,595,23.27,595,148.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 85730",2,42,8.3800000000000008,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO COMM - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99203",2,415,100,23.27,456.36,103.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99204",2,705,150.71,23.27,705,176.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99205",2,899,188.86,23.27,899,224.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99212",2,147,41.58,23.27,456.36,36.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99213",2,277,65.91,23.27,456.36,69.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99214",2,422,98.77,23.27,456.36,105.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99215",2,595,132.82,23.27,595,148.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - A9579",2,4,1.71,1.08,456.36,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - Q9963",2,1,0.43,0.22,456.36,0.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99205",2,899,899,23.27,899,224.75]
["WELLCARE - WELLCARE STANDARD - CPT - 81000",2,24,4.18,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99215",2,595,595,23.27,595,148.75]
["WELLCARE - WELLCARE STANDARD - CPT - 81002",2,17,3.62,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 76700",2,1131,220.4,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 62322",2,1426,609.47,82.95,1426,356.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 81002",2,17,8.5500000000000007,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99203",2,415,415,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99213",2,277,277,23.27,456.36,69.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 76830",2,1028,131.47999999999999,113.99,873.8,257]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 81000",2,24,4.43,2.89,456.36,6]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 99205",2,899,188.86,23.27,899,224.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 99215",2,595,132.82,23.27,595,148.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 76805",2,1192,114.99,113.99,1013.2,298]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - A9579",2,4,1.71,1.08,456.36,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 81003",2,17,3.14,1.63,456.36,4.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 99215",2,595,132.82,23.27,595,148.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 81003",2,17,8.99,1.63,456.36,4.25]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 99204",2,705,150.71,23.27,705,176.25]
["WELLCARE - WELLCARE STANDARD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99214",2,422,223.24,23.27,456.36,105.5]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99204",2,705,150.71,23.27,705,176.25]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 70553",2,6917,453.39,398.75,5879.45,1729.25]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 55700",2,2348,1003.54,420.34,3848.68,587]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99214",2,422,358.7,23.27,456.36,105.5]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99204",2,705,27.28,23.27,705,176.25]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 76700",2,1131,111.92,111.92,961.35,282.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 85730",2,42,16.39,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 81000",2,24,9.8800000000000008,2.89,456.36,6]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 99203",2,415,100,23.27,456.36,103.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 85730",2,42,16.39,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 81002",2,17,3.57,2.34,456.36,4.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 85730",2,42,6.01,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 81000",2,24,3.62,2.89,456.36,6]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 99203",2,415,100,23.27,456.36,103.75]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - A9579",2,4,4,1.08,456.36,1]
["WELLSENSE - WELLSENSE CLARITY GOLD - CPT - 85610",2,29,4.54,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99212",2,147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85730",2,42,16.39,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 70553",2,6917,2956.33,398.75,5879.45,1729.25]
["UBH HPHC - UBH HPHC - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 85730",2,42,7.21,5.3,456.36,10.5]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 85730",2,42,16.8,5.3,456.36,10.5]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 76830",2,1028,148.13,113.99,873.8,257]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 99212",2,147,178.11,23.27,456.36,36.75]
["UNITED - UNITED STANDARD - CPT - A9579",2,4,4,1.08,456.36,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 85610",2,29,5.17,3.58,456.36,7.25]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - A9579",2,4,4,1.08,456.36,1]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 76805",2,1192,113.99,113.99,1013.2,298]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 99212",2,147,102.9,23.27,456.36,36.75]
["UNICARE - UNICARE STANDARD - CPT - 70553",2,6917,748.81,398.75,5879.45,1729.25]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 85610",2,29,5.17,3.58,456.36,7.25]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - A9579",2,4,4,1.08,456.36,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - A9579",2,4,4,1.08,456.36,1]
["TUFTS - TUFTS HMO - CPT - 55700",2,2348,1505.24,420.34,3848.68,587]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 55700",2,2348,2286.9499999999998,420.34,3848.68,587]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["TUFTS - TUFTS POS - CPT - 99205",2,899,27.28,23.27,899,224.75]
["TUFTS - TUFTS PPO - CPT - 55700",2,2348,1505.24,420.34,3848.68,587]
["TUFTS TOGETHER MCO - TUFTS TOGETHER MCO - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["UBH HPHC - UBH HPHC - CPT - A9579",2,4,4,1.08,456.36,1]
["TUFTS - TUFTS SELECT - CPT - 76805",2,1192,133.25,113.99,1013.2,298]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 70553",2,6917,954.74,398.75,5879.45,1729.25]
["UNITED - UNITED NAVIGATE - CPT - 99204",2,705,328.17,23.27,705,176.25]
["TUFTS - TUFTS SPIRIT - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 55700",2,2348,420.34,420.34,3848.68,587]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - A9579",2,4,4,1.08,456.36,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 99204",2,705,148.41999999999999,23.27,705,176.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 81003",2,17,2.68,1.63,456.36,4.25]
["WELLCARE - WELLCARE HMO - CPT - 99212",2,147,154.36000000000001,23.27,456.36,36.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 76700",2,1131,123.44,111.92,961.35,282.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 99204",2,705,420.34,23.27,705,176.25]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 81000",2,24,4.0199999999999996,2.89,456.36,6]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 99203",2,415,148.41999999999999,23.27,456.36,103.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 99214",2,422,102.14,23.27,456.36,105.5]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 99204",2,705,420.34,23.27,705,176.25]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 85730",2,42,6.01,5.3,456.36,10.5]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA FAM ASSIST - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 76700",2,1131,420.34,111.92,961.35,282.75]
["TUFTS TOGETHER MCO - TUFTS TOGETHER MCO - CPT - 81000",2,24,3.55,2.89,456.36,6]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO STANDARD - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 81002",2,17,4.82,2.34,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 99214",2,422,102.14,23.27,456.36,105.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 76700",2,1131,420.34,111.92,961.35,282.75]
["UNITED - UNITED HP SHIP - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["UNITED - UNITED HP SHIP - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 81002",2,17,4.82,2.34,456.36,4.25]
["UNITED - UNITED NAVIGATE - CPT - 85610",2,29,3.86,3.58,456.36,7.25]
["UNITED - UNITED PASSPORT CONNECT - CPT - 76830",2,1028,220.4,113.99,873.8,257]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 99203",2,415,420.34,23.27,456.36,103.75]
["MEDICARE - MEDICARE PART A ONLY - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 99213",2,277,148.41999999999999,23.27,456.36,69.25]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 99203",2,415,420.34,23.27,456.36,103.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 99205",2,899,148.41999999999999,23.27,899,224.75]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 76700",2,1131,272.94,111.92,961.35,282.75]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - A9579",2,4,4,1.08,456.36,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["MEDICAID - CMSP STANDARD - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 76805",2,1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 99205",2,899,173.23000000000002,23.27,899,224.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 81003",2,17,2.36,1.63,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 99215",2,595,153.80000000000001,23.27,595,148.75]
["MEDICAID ACO - MEDICAID ACO COMM - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["MEDICARE - MEDICARE A&B - CPT - A9579",2,4,4,1.08,456.36,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 85610",2,29,11.92,3.58,456.36,7.25]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 81003",2,17,2.36,1.63,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 99215",2,595,153.80000000000001,23.27,595,148.75]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 99212",2,147,148.41999999999999,23.27,456.36,36.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 99204",2,705,147.94,23.27,705,176.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 85730",2,42,23.65,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 81003",2,17,2.36,1.63,456.36,4.25]
["MEDICAID MANAGED CARE - MCD MNG CARE CARE PLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 81003",2,17,2.36,1.63,456.36,4.25]
["HSN - HSN TEMPORARY - CPT - 99204",2,705,456.36,23.27,705,176.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 99204",2,705,147.94,23.27,705,176.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 81000",2,24,456.36,2.89,456.36,6]
["FALLON - FALLON COMMUNITY PLAN - CPT - 81002",2,17,8.5,2.34,456.36,4.25]
["FALLON - FALLON COMMUNITY PLAN - CPT - 99214",2,422,211,23.27,456.36,105.5]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["FALLON - FALLON HMO STANDARD - CPT - 99204",2,705,352.5,23.27,705,176.25]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 99204",2,705,705,23.27,705,176.25]
["FALLON - FALLON POS STANDARD - CPT - 81002",2,17,8.5,2.34,456.36,4.25]
["FALLON - FALLON POS STANDARD - CPT - 99214",2,422,211,23.27,456.36,105.5]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - CPT - 81000",2,24,3.55,2.89,456.36,6]
["MEDICAID MANAGED CARE - MCD MNG CARE COMMONHEALTH - CPT - 81002",2,17,3.07,2.34,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 99204",2,705,147.94,23.27,705,176.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 85730",2,42,16.39,5.3,456.36,10.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 81000",2,24,9.8800000000000008,2.89,456.36,6]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 COMMONHLTH - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 STANDARD - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 76830",2,1028,123.44,113.99,873.8,257]
["HSN - HSN STANDARD - CPT - 62322",2,1426,456.36,82.95,1426,356.5]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE COMMHLTH - CPT - 85730",2,42,5.3,5.3,456.36,10.5]
["HSN - HSN TEMPORARY - CPT - 99205",2,899,456.36,23.27,899,224.75]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 85610",2,29,456.36,3.58,456.36,7.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 81000",2,24,4.22,2.89,456.36,6]
["HSN DENTAL - HSN DENTAL - CPT - 99215",2,595,456.36,23.27,595,148.75]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 99205",2,899,456.36,23.27,899,224.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 85610",2,29,456.36,3.58,456.36,7.25]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO - MASS GEN BRIG HLTH PLAN ACO MYCARE FAM - CPT - 81000",2,24,3.55,2.89,456.36,6]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 81002",2,17,9.57,2.34,456.36,4.25]
["FALLON SCO - FALLON SCO HMO - CPT - 81003",2,17,2.25,1.63,456.36,4.25]
["FALLON SCO - FALLON SCO HMO - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 99213",2,277,277,23.27,456.36,69.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 99204",2,705,705,23.27,705,176.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 99213",2,277,277,23.27,456.36,69.25]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE HMO - CPT - 81000",2,24,4.08,2.89,456.36,6]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 81003",2,17,6.81,1.63,456.36,4.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 99215",2,595,595,23.27,595,148.75]
["MEDICAID - MEDICAID COMMONHEALTH - CPT - 81000",2,24,3.55,2.89,456.36,6]
["MEDICAID - MEDICAID FAMILY ASSIST - CPT - 85610",2,29,3.78,3.58,456.36,7.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS - CPT - 81000",2,24,3.55,2.89,456.36,6]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 70553",2,6917,755.93,398.75,5879.45,1729.25]
["MEDICAID LIMITED - MEDICAID LIMITED LIMITED - CPT - 81003",2,17,1.98,1.63,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 55700",2,2348,2401.3000000000002,420.34,3848.68,587]
["MEDICARE - MEDICARE A&B - CPT - 99215",2,595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99214",2,422,148.41999999999999,23.27,456.36,105.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 99205",2,899,173.23000000000002,23.27,899,224.75]
["AETNA - AETNA PPO EPO - CPT - 70553",2,6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99214",2,422,223.24,23.27,456.36,105.5]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 85610",2,29,4.29,3.58,456.36,7.25]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 85610",2,29,4.72,3.58,456.36,7.25]
["BCBS - BCBS HMO - CPT - 81002",2,17,5.73,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 99205",2,899,176.94,23.27,899,224.75]
["BCBS - BCBS INDEMNITY - CPT - 99203",2,415,32.18,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 55700",2,2348,2286.9499999999998,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 99212",2,147,96.429999999999993,23.27,456.36,36.75]
["BCBS - BCBS POS - CPT - 99213",2,277,32.18,23.27,456.36,69.25]
["BCBS - BCBS PPO - CPT - 70553",2,6917,961.1,398.75,5879.45,1729.25]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76805",2,1192,123.44,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["BCBS - BCBS SHIP PPO - CPT - 99213",2,277,32.18,23.27,456.36,69.25]
["BCBS - BCBS STANDARD - CPT - 70553",2,6917,961.1,398.75,5879.45,1729.25]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 99215",2,595,153.80000000000001,23.27,595,148.75]
["BCBS - BCBS STANDARD - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 81000",2,24,6.3,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 66821",2,2811,685.29,420.34,2389.35,702.75]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 99215",2,595,32.18,23.27,595,148.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 81003",2,17,2.36,1.63,456.36,4.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 81000",2,24,4.0199999999999996,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 99213",2,277,116.25,23.27,456.36,69.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 62322",2,1426,1426,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 85730",2,42,12.03,5.3,456.36,10.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 85730",2,42,12.03,5.3,456.36,10.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 85730",2,42,6.31,5.3,456.36,10.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 99212",2,147,32.18,23.27,456.36,36.75]
["CCA - CCA SCO ONECARE - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - A9579",2,4,4,1.08,456.36,1]
["CCA - CCA SCO ONECARE - CPT - A9579",2,4,4,1.08,456.36,1]
["CCA - CCA SCO STANDARD - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["CCA - CCA SCO STANDARD - CPT - 99203",2,415,155.85,23.27,456.36,103.75]
["CCA - ZZZCCA STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - A9579",2,4,4,1.08,456.36,1]
["CCA - ZZZCCA STANDARD - CPT - A9579",2,4,4,1.08,456.36,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 76830",2,1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 80048",2,167,8.8800000000000008,7.46,456.36,41.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 55700",2,2348,2401.3000000000002,420.34,3848.68,587]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 85610",2,29,4.5,3.58,456.36,7.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 76700",2,1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 19120",2,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 72193",2,3040,216.61,190.5,2584,760]
["CIGNA - CIGNA CARELINK - CPT - 55700",2,2348,1505.24,420.34,3848.68,587]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - Q9963",2,1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - P9047",2,180,55.73,50.13,456.36,45]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 99204",2,705,151.65,23.27,705,176.25]
["CIGNA - CIGNA LOCALPLUS - CPT - 99204",2,705,599.25,23.27,705,176.25]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 70553",2,6917,453.39,398.75,5879.45,1729.25]
["AETNA - AETNA POS - CPT - 81002",2,17,8.99,2.34,456.36,4.25]
["CIGNA - CIGNA STANDARD - CPT - 99214",2,422,358.7,23.27,456.36,105.5]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 85730",2,42,6.31,5.3,456.36,10.5]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 81000",2,24,4.22,2.89,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 70553",2,6917,453.39,398.75,5879.45,1729.25]
["AETNA - AETNA POS - CPT - 99213",2,277,146.53,23.27,456.36,69.25]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 99214",2,422,128.995,23.27,456.36,105.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 85730",2,42,6.31,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 81000",2,24,4.22,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62322",2,1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 81002",2,17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 70553",2,6917,453.39,398.75,5879.45,1729.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 80055",1,260,111.12,18.32,456.36,65]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 66984",1,2224,1176.5,420.34,4241.13,556]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 62323",1,1485,1262.25,420.34,1505.24,371.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 90834",1,215,91.89,27.84,456.36,53.75]
["WELLSENSE - WELLSENSE CLARITY BRONZE - CPT - 85025",1,55,8.2200000000000006,6.85,456.36,13.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["ZZZAETNA - ZZZAETNA POS - CPT - 66821",1,2811,1487.02,420.34,2389.35,702.75]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 43239",1,1712,731.71,420.34,1871.88,428]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 64483",1,1545,1505.24,420.34,1879.97,386.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 80055",1,260,111.12,18.32,456.36,65]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY CARE PLUS - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 90834",1,215,91.89,27.84,456.36,53.75]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 45385",1,3040,1608.16,420.34,2929.62,760]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - A9581",1,99,42.31,15.3,456.36,24.75]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - J3301",1,18,7.69,0.98,456.36,4.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 85027",1,45,9.0399999999999991,5.71,456.36,11.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 29881",1,5454,2331.04,420.34,5454,1363.5]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 74177",1,3263,1394.61,398.75,2773.55,815.75]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 80055",1,260,111.12,18.32,456.36,65]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 90686",1,74,22.35,19.16,456.36,18.5]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 90837",1,215,215,27.84,456.36,53.75]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 74177",1,3263,755.93,398.75,2773.55,815.75]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - A9500",1,357,152.58000000000001,128.52000000000001,456.36,89.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 80076",1,163,86.23,7.21,456.36,40.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 77066",1,924,488.8,131.5,924,231]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 64483",1,1545,660.33,420.34,1879.97,386.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 74177",1,3263,1394.61,398.75,2773.55,815.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - Q9958",1,1,0.43,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 84153",1,125,25.7,13.26,456.36,31.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 90832",1,168,71.8,21.97,456.36,42]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 90847",1,363,155.15,30.9,456.36,90.75]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - A9500",1,357,152.58000000000001,128.52000000000001,456.36,89.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 85027",1,45,7.16,5.71,456.36,11.25]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 43235",1,1505,643.24,420.34,1871.88,376.25]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 64483",1,1545,660.33,420.34,1879.97,386.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 66984",1,2224,4241.13,420.34,4241.13,556]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 80053",1,271,14.77,9.31,456.36,67.75]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 84153",1,125,25.7,13.26,456.36,31.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 99386",1,640,321.92,23.27,640,160]
["WELLCARE - WELLCARE STANDARD - CPT - 66984",1,2224,2721.21,420.34,4241.13,556]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - J1030",1,13,5.56,4.68,456.36,3.25]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 43235",1,1505,643.24,420.34,1871.88,376.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 77065",1,752,752,102.59,752,188]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 73721",1,5064,578.29999999999995,254.07,4304.3999999999996,1266]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 72148",1,4633,451.66,254.07,3938.05,1158.25]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 80053",1,271,14.77,9.31,456.36,67.75]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 84153",1,125,25.7,13.26,456.36,31.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 84443",1,114,60.31,14.82,456.36,28.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 80069",1,195,103.16,7.66,456.36,48.75]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - J1030",1,13,5.56,4.68,456.36,3.25]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 43235",1,1505,643.24,420.34,1871.88,376.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 66821",1,2811,652.66,420.34,2389.35,702.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 73721",1,5064,578.29999999999995,254.07,4304.3999999999996,1266]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 80053",1,271,14.77,9.31,456.36,67.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 90715",1,180,76.930000000000007,39.75,456.36,45]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 97110",1,249,23.1,23.1,456.36,62.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - J1030",1,13,5.56,4.68,456.36,3.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 80053",1,271,11.69,9.31,456.36,67.75]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 62323",1,1485,634.69000000000005,420.34,1505.24,371.25]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 73721",1,5064,578.29999999999995,254.07,4304.3999999999996,1266]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 95810",1,3935,2717.96,420.34,3344.75,983.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG CARE PLUS - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 90715",1,180,76.930000000000007,39.75,456.36,45]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - Q9958",1,1,0.43,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 45380",1,2575,1100.56,420.34,2575,643.75]
["WORKERS COMP - WORKERS COMP MBTA - CPT - Q9958",1,1,0.43,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 29881",1,5454,2331.04,420.34,5454,1363.5]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 62323",1,1485,634.69000000000005,420.34,1505.24,371.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 73721",1,5064,451.66,254.07,4304.3999999999996,1266]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 95810",1,3935,774.82,420.34,3344.75,983.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 90686",1,74,22.35,19.16,456.36,18.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 29881",1,5454,5454,420.34,5454,1363.5]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 99385",1,530,226.52,23.27,530,132.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - A9575",1,8,8,0.13,456.36,2]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 72193",1,3040,395.2,190.5,2584,760]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99385",1,530,266.58999999999997,23.27,530,132.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 73721",1,5064,275.13,254.07,4304.3999999999996,1266]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 80048",1,167,11.83,7.46,456.36,41.75]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 62323",1,1485,1485,420.34,1505.24,371.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 90832",1,168,168,21.97,456.36,42]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 95810",1,3935,774.82,420.34,3344.75,983.75]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 99385",1,530,226.52,23.27,530,132.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - J3301",1,18,18,0.98,456.36,4.5]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 19120",1,4199,1794.65,420.34,6229.57,1049.75]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 29881",1,5454,2331.04,420.34,5454,1363.5]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - A9517",1,523,36.409999999999997,20.12,456.36,130.75]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 72193",1,3040,332.53,190.5,2584,760]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 80048",1,167,11.83,7.46,456.36,41.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 66821",1,2811,1443.05,420.34,2389.35,702.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90837",1,215,215,27.84,456.36,53.75]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 95810",1,3935,774.82,420.34,3344.75,983.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["WELLCARE - WELLCARE STANDARD - CPT - A9513",1,429,302.06,154.44,456.36,107.25]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 19120",1,4199,1794.65,420.34,6229.57,1049.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 19120",1,4199,2221.27,420.34,6229.57,1049.75]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 72193",1,3040,332.53,190.5,2584,760]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 80076",1,163,86.23,7.21,456.36,40.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 90847",1,363,192.03,30.9,456.36,90.75]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 90686",1,74,31.63,19.16,456.36,18.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 45380",1,2575,1362.18,420.34,2575,643.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["WELLCARE - WELLCARE PPO - CPT - A9517",1,523,22.19,20.12,456.36,130.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 19120",1,4199,1794.65,420.34,6229.57,1049.75]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - Q9958",1,1,0.53,0.09,456.36,0.25]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 85025",1,55,8.2200000000000006,6.85,456.36,13.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 80076",1,163,11.42,7.21,456.36,40.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - A9517",1,523,223.53,20.12,456.36,130.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 45380",1,2575,1391.24,420.34,2575,643.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 84443",1,114,14.82,14.82,456.36,28.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 72148",1,4633,579.80999999999995,254.07,3938.05,1158.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81001",1,24,2.8,2.8,456.36,6]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - P9047",1,180,55.73,50.13,456.36,45]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 93452",1,6358,2717.41,420.34,6358,1589.5]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 90834",1,215,182.75,27.84,456.36,53.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["WELLCARE - WELLCARE STANDARD - CPT - 90837",1,215,186.18,27.84,456.36,53.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 74177",1,3263,1213.81,398.75,2773.55,815.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 84443",1,114,45.94,14.82,456.36,28.5]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 80048",1,167,11.83,7.46,456.36,41.75]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 90662",1,129,55.13,36.119999999999997,456.36,32.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 93452",1,6358,2717.41,420.34,6358,1589.5]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 80055",1,260,18.32,18.32,456.36,65]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - A9575",1,8,3.42,0.13,456.36,2]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 90834",1,215,182.75,27.84,456.36,53.75]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 74177",1,3263,1394.61,398.75,2773.55,815.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 77066",1,924,394.92,131.5,924,231]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - A9500",1,357,152.58000000000001,128.52000000000001,456.36,89.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 90662",1,129,55.13,36.119999999999997,456.36,32.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 93452",1,6358,2717.41,420.34,6358,1589.5]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 80055",1,260,47.81,18.32,456.36,65]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - A9575",1,8,3.42,0.13,456.36,2]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 19120",1,4199,1511.64,420.34,6229.57,1049.75]
["WELLSENSE - WELLSENSE CHOICE - CPT - 81001",1,24,3.36,2.8,456.36,6]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 72110",1,595,46.45,46.45,595,148.75]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 77066",1,924,394.92,131.5,924,231]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 84443",1,114,23.47,14.82,456.36,28.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 90662",1,129,55.13,36.119999999999997,456.36,32.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 66984",1,2224,4241.13,420.34,4241.13,556]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 72193",1,3040,1094.4000000000001,190.5,2584,760]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - A9575",1,8,3.42,0.13,456.36,2]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - A9513",1,429,285.07,154.44,456.36,107.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 45391",1,2924,1249.72,420.34,2924,731]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 72110",1,595,46.45,46.45,595,148.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 84443",1,114,51,14.82,456.36,28.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 73721",1,5064,578.29999999999995,254.07,4304.3999999999996,1266]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 77066",1,924,394.92,131.5,924,231]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 90853",1,129,55.13,15.63,456.36,32.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 85027",1,45,5.91,5.71,456.36,11.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 90834",1,215,108.15,27.84,456.36,53.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - A9513",1,429,285.07,154.44,456.36,107.25]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 45391",1,2924,1249.72,420.34,2924,731]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 74177",1,3263,431.8,398.75,2773.55,815.75]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 93452",1,6358,2288.88,420.34,6358,1589.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - P9047",1,180,53.08,50.13,456.36,45]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 93452",1,6358,2717.41,420.34,6358,1589.5]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 80069",1,195,7.81,7.66,456.36,48.75]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 90846",1,308,308,30.9,456.36,77]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - Q9966",1,1,0.43,0.36,456.36,0.25]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 45385",1,3040,2408.3200000000002,420.34,2929.62,760]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 77065",1,752,752,102.59,752,188]
["ZZZAETNA - ZZZAETNA HMO - CPT - 77065",1,752,397.81,102.59,752,188]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - P9047",1,180,64.8,50.13,456.36,45]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 90847",1,363,192.03,30.9,456.36,90.75]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 90662",1,129,55.13,36.119999999999997,456.36,32.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 90686",1,74,31.63,19.16,456.36,18.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 45385",1,3040,2408.3200000000002,420.34,2929.62,760]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 77065",1,752,752,102.59,752,188]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 77065",1,752,397.81,102.59,752,188]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - P9047",1,180,76.930000000000007,50.13,456.36,45]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 19120",1,4199,1794.65,420.34,6229.57,1049.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 90847",1,363,192.03,30.9,456.36,90.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9575",1,8,8,0.13,456.36,2]
["UNITED - UNITED NAVIGATE - CPT - 70450",1,2022,272.94,113.99,1718.7,505.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 99385",1,530,420.34,23.27,530,132.5]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["UBH HPHC - UBH HPHC - CPT - 95810",1,3935,1173.94,420.34,3344.75,983.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 90837",1,215,215,27.84,456.36,53.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 72193",1,3040,420.34,190.5,2584,760]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST - CPT - 80076",1,163,7.21,7.21,456.36,40.75]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 73721",1,5064,608.33000000000004,254.07,4304.3999999999996,1266]
["UNITED - UNITED PASSPORT CONNECT - CPT - 72148",1,4633,451.66,254.07,3938.05,1158.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 95810",1,3935,420.34,420.34,3344.75,983.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 74177",1,3263,431.8,398.75,2773.55,815.75]
["WELLCARE - WELLCARE PPO - CPT - 19120",1,4199,4451.04,420.34,6229.57,1049.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 19120",1,4199,420.34,420.34,6229.57,1049.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - J1030",1,13,13,4.68,456.36,3.25]
["UNICARE - UNICARE STANDARD - CPT - 90837",1,215,161.25,27.84,456.36,53.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 77067",1,488,420.34,108.47,488,122]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 66821",1,2811,652.66,420.34,2389.35,702.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 90832",1,168,420.34,21.97,456.36,42]
["TUFTS - TUFTS SELECT - CPT - 66984",1,2224,1754.93,420.34,4241.13,556]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 90853",1,129,100.08,15.63,456.36,32.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 62323",1,1485,931.77,420.34,1505.24,371.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 19120",1,4199,5926.3,420.34,6229.57,1049.75]
["WELLCARE - WELLCARE HMO - CPT - 43239",1,1712,1058.52,420.34,1871.88,428]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 72148",1,4633,380.97,254.07,3938.05,1158.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 77067",1,488,108.47,108.47,488,122]
["TUFTS - TUFTS HMO - CPT - 72193",1,3040,558.08000000000004,190.5,2584,760]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO CARE PLUS - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["TUFTS - TUFTS HMO - CPT - 95810",1,3935,2553.0100000000002,420.34,3344.75,983.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - A9513",1,429,402.17,154.44,456.36,107.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - P9047",1,180,73.5,50.13,456.36,45]
["UNITED - UNITED HP SHIP - CPT - 19120",1,4199,6229.57,420.34,6229.57,1049.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 66821",1,2811,420.34,420.34,2389.35,702.75]
["UNITED - UNITED HP SHIP - CPT - J1030",1,13,13,4.68,456.36,3.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 85025",1,55,9.32,6.85,456.36,13.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 80061",1,129,16,11.81,456.36,32.25]
["UNITED - UNITED PASSPORT CONNECT - CPT - 90715",1,180,180,39.75,456.36,45]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 90834",1,215,420.34,27.84,456.36,53.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 90846",1,308,214.82,30.9,456.36,77]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - A9513",1,429,420.34,154.44,456.36,107.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - P9047",1,180,420.34,50.13,456.36,45]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 62323",1,1485,776.47,420.34,1505.24,371.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 66821",1,2811,903.73,420.34,2389.35,702.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - A9513",1,429,348.53,154.44,456.36,107.25]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - A9517",1,523,21.34,20.12,456.36,130.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 84443",1,114,23.26,14.82,456.36,28.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 90846",1,308,247.88,30.9,456.36,77]
["WELLCARE - WELLCARE HMO - CPT - 85025",1,55,8.08,6.85,456.36,13.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 90853",1,129,420.34,15.63,456.36,32.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 45391",1,2924,420.34,420.34,2924,731]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 72110",1,595,420.34,46.45,595,148.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY - CPT - 84443",1,114,14.82,14.82,456.36,28.5]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 64483",1,1545,1228.0999999999999,420.34,1879.97,386.25]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["UBH HPHC - UBH HPHC - CPT - 45391",1,2924,1324.99,420.34,2924,731]
["MEDICARE - MEDICARE PART B ONLY - CPT - 66821",1,2811,652.66,420.34,2389.35,702.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - Q9966",1,1,420.34,0.36,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 45391",1,2924,1834.71,420.34,2924,731]
["TUFTS - TUFTS POS - CPT - 72193",1,3040,558.08000000000004,190.5,2584,760]
["UNITED - UNITED DEFINITY HRA - CPT - 80048",1,167,7.61,7.46,456.36,41.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - 66984",1,2224,2616.5500000000002,420.34,4241.13,556]
["UNITED - UNITED HP SHIP - CPT - 72193",1,3040,395.2,190.5,2584,760]
["UNITED - UNITED HP SHIP - CPT - 97110",1,249,145.28,23.1,456.36,62.25]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 90832",1,168,214.82,21.97,456.36,42]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 90662",1,129,73.400000000000006,36.119999999999997,456.36,32.25]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 99386",1,640,321.92,23.27,640,160]
["TUFTS - TUFTS PPO - CPT - 72148",1,4633,770.9,254.07,3938.05,1158.25]
["UNITED - UNITED NAVIGATE - CPT - P9047",1,180,138.30000000000001,50.13,456.36,45]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 80053",1,271,12.61,9.31,456.36,67.75]
["UNITED - UNITED PASSPORT CONNECT - CPT - 99386",1,640,321.92,23.27,640,160]
["UNITED - UNITED STANDARD - CPT - 74177",1,3263,954.74,398.75,2773.55,815.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 97110",1,249,420.34,23.1,456.36,62.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 99386",1,640,420.34,23.27,640,160]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 90834",1,215,179.02,27.84,456.36,53.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["MEDICARE - MEDICARE PART B ONLY - CPT - 70450",1,2022,123.44,113.99,1718.7,505.5]
["TUFTS - TUFTS SELECT - CPT - 80053",1,271,10.91,9.31,456.36,67.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 73721",1,5064,380.97,254.07,4304.3999999999996,1266]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 80053",1,271,14.62,9.31,456.36,67.75]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - A9581",1,99,99,15.3,456.36,24.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 80053",1,271,10.56,9.31,456.36,67.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - 72148",1,4633,275.13,254.07,3938.05,1158.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 73721",1,5064,275.13,254.07,4304.3999999999996,1266]
["TUFTS - TUFTS SPIRIT - CPT - 72110",1,595,123.44,46.45,595,148.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 45380",1,2575,420.34,420.34,2575,643.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 90832",1,168,179.02,21.97,456.36,42]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - A9513",1,429,290.44,154.44,456.36,107.25]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 73721",1,5064,608.33000000000004,254.07,4304.3999999999996,1266]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 19120",1,4199,1679.6,420.34,6229.57,1049.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 90846",1,308,420.34,30.9,456.36,77]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - A9555",1,1385,554,420.34,1385,346.25]
["WELLCARE - WELLCARE HMO - CPT - 77066",1,924,131.5,131.5,924,231]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - Q9958",1,1,420.34,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 45380",1,2575,1834.71,420.34,2575,643.75]
["TUFTS - TUFTS CARELINK - CPT - 90853",1,129,18.329999999999998,15.63,456.36,32.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 77066",1,924,131.5,131.5,924,231]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 85027",1,45,8.9600000000000009,5.71,456.36,11.25]
["TUFTS - TUFTS CARELINK - CPT - J3301",1,18,18,0.98,456.36,4.5]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA FAM ASSIST - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["MEDICARE - MEDICARE PART A ONLY - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 19120",1,4199,420.34,420.34,6229.57,1049.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 72148",1,4633,420.34,254.07,3938.05,1158.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 77067",1,488,420.34,108.47,488,122]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY STANDARD - CPT - 80055",1,260,42.17,18.32,456.36,65]
["TUFTS TOGETHER MCO - TUFTS TOGETHER MCO - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO CARE PLUS - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 43235",1,1505,939.89,420.34,1871.88,376.25]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 43239",1,1712,939.89,420.34,1871.88,428]
["UBH HPHC - UBH HPHC - CPT - 72110",1,595,123.44,46.45,595,148.75]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 45391",1,2924,1223.56,420.34,2924,731]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 72148",1,4633,275.13,254.07,3938.05,1158.25]
["TUFTS - TUFTS HMO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["TUFTS - TUFTS POS - CPT - 29881",1,5454,5454,420.34,5454,1363.5]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 90662",1,129,36.119999999999997,36.119999999999997,456.36,32.25]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 77066",1,924,135.71,131.5,924,231]
["UNITED - UNITED DEFINITY HRA - CPT - 19120",1,4199,4199,420.34,6229.57,1049.75]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["UNITED - UNITED DEFINITY HRA - CPT - 72193",1,3040,456.13,190.5,2584,760]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 62323",1,1485,776.47,420.34,1505.24,371.25]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 73721",1,5064,275.13,254.07,4304.3999999999996,1266]
["UNITED - UNITED DEFINITY HRA - CPT - J1030",1,13,13,4.68,456.36,3.25]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 84443",1,114,20.239999999999998,14.82,456.36,28.5]
["TUFTS - TUFTS POS - CPT - 90847",1,363,36.229999999999997,30.9,456.36,90.75]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 97110",1,249,32.11,23.1,456.36,62.25]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - A9513",1,429,290.44,154.44,456.36,107.25]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 43235",1,1505,1871.88,420.34,1871.88,376.25]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 43239",1,1712,1017.81,420.34,1871.88,428]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 66821",1,2811,652.66,420.34,2389.35,702.75]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 97110",1,249,145.28,23.1,456.36,62.25]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 80055",1,260,47.81,18.32,456.36,65]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["UNITED - UNITED NAVIGATE - CPT - 80048",1,167,7.61,7.46,456.36,41.75]
["TRICARE EAST - TRICARE EAST SELECT - CPT - A9581",1,99,99,15.3,456.36,24.75]
["UNITED - UNITED NAVIGATE - CPT - A9513",1,429,429,154.44,456.36,107.25]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["UNITED - UNITED PASSPORT CONNECT - CPT - 84443",1,114,51,14.82,456.36,28.5]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 29881",1,5454,611.83000000000004,420.34,5454,1363.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 80069",1,195,8.68,7.66,456.36,48.75]
["UNITED - UNITED STANDARD - CPT - 64483",1,1545,1545,420.34,1879.97,386.25]
["UNITED - UNITED STANDARD - CPT - 80055",1,260,43.03,18.32,456.36,65]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 62323",1,1485,717.03,420.34,1505.24,371.25]
["TUFTS - TUFTS PPO - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["TUFTS - TUFTS SELECT - CPT - 19120",1,4199,2746.49,420.34,6229.57,1049.75]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 85027",1,45,6.47,5.71,456.36,11.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 77065",1,752,102.59,102.59,752,188]
["MEDICARE - MEDICARE PART B ONLY - CPT - A9513",1,429,290.44,154.44,456.36,107.25]
["TUFTS - TUFTS SELECT - CPT - 74177",1,3263,458.44,398.75,2773.55,815.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 90846",1,308,179.02,30.9,456.36,77]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - A9575",1,8,8,0.13,456.36,2]
["TUFTS - TUFTS SELECT - CPT - 85027",1,45,6.68,5.71,456.36,11.25]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 77067",1,488,108.47,108.47,488,122]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 72148",1,4633,275.13,254.07,3938.05,1158.25]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - J1030",1,13,13,4.68,456.36,3.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 90662",1,129,36.119999999999997,36.119999999999997,456.36,32.25]
["TUFTS - TUFTS SELECT - CPT - A9575",1,8,8,0.13,456.36,2]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 95810",1,3935,1173.94,420.34,3344.75,983.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - A9581",1,99,99,15.3,456.36,24.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 66821",1,2811,652.66,420.34,2389.35,702.75]
["TUFTS TOGETHER ACO - TUFTS TOGETHER ACO CHA - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["TUFTS TOGETHER ACO - TUFTS TOGETHER ACO UMASS MEMORIAL - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - A9517",1,523,21.34,20.12,456.36,130.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 85025",1,55,7.77,6.85,456.36,13.75]
["TUFTS - TUFTS SPIRIT - CPT - 85027",1,45,6.47,5.71,456.36,11.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH - CPT - 81001",1,24,2.8,2.8,456.36,6]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["TUFTS - TUFTS CARELINK - CPT - 66821",1,2811,1505.24,420.34,2389.35,702.75]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["TUFTS - TUFTS SPIRIT - CPT - A9581",1,99,99,15.3,456.36,24.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 77066",1,924,369.6,131.5,924,231]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 90662",1,129,51.6,36.119999999999997,456.36,32.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH CARE PLUS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["TUFTS - TUFTS CARELINK - CPT - 80061",1,129,36.619999999999997,11.81,456.36,32.25]
["WELLCARE - WELLCARE HMO - CPT - 72110",1,595,128.38,46.45,595,148.75]
["WELLCARE - WELLCARE HMO - CPT - 80053",1,271,10.98,9.31,456.36,67.75]
["WELLCARE - WELLCARE HMO - CPT - 97110",1,249,33.39,23.1,456.36,62.25]
["MEDICARE - MEDICARE PART B ONLY - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["WELLCARE - WELLCARE PPO - CPT - 64483",1,1545,1064.3499999999999,420.34,1879.97,386.25]
["WELLCARE - WELLCARE PPO - CPT - 80055",1,260,49.72,18.32,456.36,65]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["FALLON - FALLON PPO STANDARD - CPT - 90686",1,74,37,19.16,456.36,18.5]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 93452",1,6358,456.36,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 72193",1,3040,216.61,190.5,2584,760]
["FALLON HEALTHCRE ACO - FALLON HEALTHCARE ACO ATRIUS - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["MEDICAID MANAGED CARE - MCD MNG CARE FAMILY ASSIST - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["HSN DENTAL - HSN DENTAL - CPT - 45385",1,3040,456.36,420.34,2929.62,760]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO BRKSHRE - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO RELIANT - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["MEDICAID - MEDICAID CARE PLUS - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 CARE PLUS - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 CARE PLUS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["HSN DENTAL - HSN DENTAL - CPT - 99385",1,530,456.36,23.27,530,132.5]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 80069",1,195,456.36,7.66,456.36,48.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 STANDARD - CPT - 80048",1,167,7.46,7.46,456.36,41.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 90846",1,308,187.97,30.9,456.36,77]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGH HLTHPLAN MCD MNG CMA - CPT - 81001",1,24,2.8,2.8,456.36,6]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE CAREPLUS - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["FALLON - FALLON HMO STANDARD - CPT - 29881",1,5454,2727,420.34,5454,1363.5]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["FALLON - FALLON POS STANDARD - CPT - 90846",1,308,154,30.9,456.36,77]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["HSN DENTAL - HSN DENTAL - CPT - 77067",1,488,456.36,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE COMMHLTH - CPT - 80055",1,260,42.17,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 72148",1,4633,2609.31,254.07,3938.05,1158.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 62323",1,1485,836.35,420.34,1505.24,371.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 90853",1,129,72.650000000000006,15.63,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 72193",1,3040,206.3,190.5,2584,760]
["MEDICAID ACO - MEDICAID ACO STEWRD FAM ASSIS - CPT - 80069",1,195,7.66,7.66,456.36,48.75]
["MEDICAID ACO - ZZZMEDICAID ACO COMM STANDARD - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 90686",1,74,20.72,19.16,456.36,18.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 97110",1,249,32.11,23.1,456.36,62.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["MEDICARE - MEDICARE A&B - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 77067",1,488,108.47,108.47,488,122]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 64483",1,1545,1023.42,420.34,1879.97,386.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 84153",1,125,18.39,13.26,456.36,31.25]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 90834",1,215,456.36,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["HSN DENTAL - HSN DENTAL - CPT - 74177",1,3263,456.36,398.75,2773.55,815.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 45380",1,2575,1391.24,420.34,2575,643.75]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - A9513",1,429,456.36,154.44,456.36,107.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 80061",1,129,13.39,11.81,456.36,32.25]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 64483",1,1545,1023.42,420.34,1879.97,386.25]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 90834",1,215,179.02,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 72193",1,3040,216.61,190.5,2584,760]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 62323",1,1485,836.35,420.34,1505.24,371.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 77066",1,924,131.5,131.5,924,231]
["FALLON SCO - FALLON SCO HMO - CPT - 45385",1,3040,1324.99,420.34,2929.62,760]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - A9581",1,99,55.76,15.3,456.36,24.75]
["FALLON SCO - FALLON SCO HMO - CPT - 80076",1,163,8.17,7.21,456.36,40.75]
["FALLON - FALLON COMMUNITY PLAN - CPT - 73721",1,5064,2532,254.07,4304.3999999999996,1266]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 90846",1,308,187.97,30.9,456.36,77]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1 - CPT - 80053",1,271,10.71,9.31,456.36,67.75]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - CPT - 85027",1,45,6.57,5.71,456.36,11.25]
["FALLON - FALLON HMO STANDARD - CPT - 43235",1,1505,752.5,420.34,1871.88,376.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 77066",1,924,924,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 77067",1,488,108.47,108.47,488,122]
["MEDICAID - MEDICAID CORRECTIONS IP - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 90853",1,129,64.89,15.63,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["MEDICAID ACO - MEDICAID ACO STEWRD - CPT - 80055",1,260,42.17,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - P9047",1,180,55.73,50.13,456.36,45]
["MEDICAID ACO - ZZZMEDICAID ACO COMM FAM ASSIST - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 72110",1,595,595,46.45,595,148.75]
["FALLON - FALLON POS STANDARD - CPT - 80069",1,195,97.5,7.66,456.36,48.75]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD COMMONHLT - CPT - 80055",1,260,42.17,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 90853",1,129,64.89,15.63,456.36,32.25]
["MEDICAID MANAGED CARE - MCD MNG CARE ESSENTIAL - CPT - 84153",1,125,16.22,13.26,456.36,31.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["MEDICARE - MEDICARE A&B - CPT - 90832",1,168,179.02,21.97,456.36,42]
["MEDICARE - MEDICARE PART A ONLY - CPT - 77066",1,924,131.5,131.5,924,231]
["HSN - HSN TEMPORARY - CPT - 85027",1,45,456.36,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 77066",1,924,131.5,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 80055",1,260,50.2,18.32,456.36,65]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 66984",1,2224,456.36,420.34,4241.13,556]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 81001",1,24,3.33,2.8,456.36,6]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["HSN BAD DEBT - HSN BAD DEBT - CPT - A9513",1,429,456.36,154.44,456.36,107.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 66984",1,2224,4241.13,420.34,4241.13,556]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 77065",1,752,752,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 90846",1,308,187.97,30.9,456.36,77]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - P9047",1,180,456.36,50.13,456.36,45]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 90847",1,363,182.59,30.9,456.36,90.75]
["HSN DENTAL - HSN DENTAL - CPT - 66984",1,2224,456.36,420.34,4241.13,556]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 66984",1,2224,2747.38,420.34,4241.13,556]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["HSN DENTAL - HSN DENTAL - CPT - A9513",1,429,456.36,154.44,456.36,107.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 45385",1,3040,2408.3200000000002,420.34,2929.62,760]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 77065",1,752,752,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - P9047",1,180,55.73,50.13,456.36,45]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - P9047",1,180,456.36,50.13,456.36,45]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 90847",1,363,182.59,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 90834",1,215,456.36,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 45385",1,3040,2408.3200000000002,420.34,2929.62,760]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 74177",1,3263,431.8,398.75,2773.55,815.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 80048",1,167,25.66,7.46,456.36,41.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 90847",1,363,182.59,30.9,456.36,90.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 90853",1,129,72.650000000000006,15.63,456.36,32.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - A9575",1,8,4.51,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 72110",1,595,335.1,46.45,595,148.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["FALLON - FALLON COMMUNITY PLAN - CPT - 29881",1,5454,2727,420.34,5454,1363.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 90853",1,129,72.650000000000006,15.63,456.36,32.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 70450",1,2022,220.4,113.99,1718.7,505.5]
["FALLON - FALLON COMMUNITY PLAN - CPT - 77065",1,752,376,102.59,752,188]
["FALLON - FALLON COMMUNITY PLAN - CPT - 80061",1,129,64.5,11.81,456.36,32.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 85025",1,55,21.21,6.85,456.36,13.75]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC - CPT - 85025",1,55,6.85,6.85,456.36,13.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - J3301",1,18,18,0.98,456.36,4.5]
["FALLON - FALLON COMMUNITY PLAN - CPT - 93452",1,6358,3179,420.34,6358,1589.5]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1 - CPT - 80048",1,167,8.58,7.46,456.36,41.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 45380",1,2575,2408.3200000000002,420.34,2575,643.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - CPT - 80055",1,260,48.5,18.32,456.36,65]
["FALLON - FALLON COMMUNITY PLAN - CPT - P9047",1,180,90,50.13,456.36,45]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 80069",1,195,26.35,7.66,456.36,48.75]
["FALLON - FALLON HMO STANDARD - CPT - 19120",1,4199,2099.5,420.34,6229.57,1049.75]
["FALLON - FALLON HMO STANDARD - CPT - 45385",1,3040,1520,420.34,2929.62,760]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 90846",1,308,154.91999999999999,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["MEDICAID - CMSP STANDARD - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["FALLON - FALLON HMO STANDARD - CPT - 77067",1,488,244,108.47,488,122]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 45380",1,2575,2408.3200000000002,420.34,2575,643.75]
["MEDICAID - MEDICAID EAEDC - CPT - 80053",1,271,9.31,9.31,456.36,67.75]
["MEDICAID - MEDICAID FAMILY ASSIST - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 80069",1,195,26.35,7.66,456.36,48.75]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 90846",1,308,154.91999999999999,30.9,456.36,77]
["FALLON - FALLON HMO STANDARD - CPT - A9500",1,357,178.5,128.52000000000001,456.36,89.25]
["MEDICAID ACO - MEDICAID ACO STEWRD - CPT - 84443",1,114,14.82,14.82,456.36,28.5]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["FALLON - FALLON POS STANDARD - CPT - 45391",1,2924,1462,420.34,2924,731]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 45385",1,3040,1324.99,420.34,2929.62,760]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG COMMONHLT - CPT - 80061",1,129,11.81,11.81,456.36,32.25]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG FAM ASSIS - CPT - 85027",1,45,5.71,5.71,456.36,11.25]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - CPT - 81001",1,24,2.8,2.8,456.36,6]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["FALLON - FALLON POS STANDARD - CPT - 90715",1,180,90,39.75,456.36,45]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD FAM ASSIS - CPT - 84443",1,114,14.82,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["FALLON - FALLON POS STANDARD - CPT - A9552",1,1015,507.5,365.4,1015,253.75]
["HSN - HSN STANDARD - CPT - 77066",1,924,456.36,131.5,924,231]
["HSN - HSN STANDARD - CPT - 81001",1,24,456.36,2.8,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["MEDICARE - MEDICARE A&B - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["HSN - HSN STANDARD - CPT - A9575",1,8,456.36,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 72193",1,3040,216.61,190.5,2584,760]
["MEDICARE - MEDICARE A&B - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["HSN - HSN TEMPORARY - CPT - 72110",1,595,456.36,46.45,595,148.75]
["HSN - HSN TEMPORARY - CPT - 77066",1,924,456.36,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["BCBS - BCBS INDEMNITY - CPT - 43239",1,1712,1401.24,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 90853",1,129,100.08,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 84153",1,125,18.39,13.26,456.36,31.25]
["AETNA - AETNA MCR SUPP - CPT - 80055",1,260,137.54,18.32,456.36,65]
["BCBS - BCBS INDEMNITY - CPT - 95810",1,3935,1679.52,420.34,3344.75,983.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 19120",1,4199,5181.41,420.34,6229.57,1049.75]
["AETNA - AETNA MCR SUPP - CPT - 81001",1,24,12.7,2.8,456.36,6]
["AETNA - AETNA HMO - CPT - 90834",1,215,113.74,27.84,456.36,53.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 77067",1,488,177.13,108.47,488,122]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 85025",1,55,15.47,6.85,456.36,13.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 90686",1,74,22.35,19.16,456.36,18.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["BCBS - BCBS POS - CPT - 90662",1,129,73.400000000000006,36.119999999999997,456.36,32.25]
["AETNA - AETNA MCR SUPP - CPT - 90853",1,129,68.239999999999995,15.63,456.36,32.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 19120",1,4199,5181.41,420.34,6229.57,1049.75]
["BCBS - BCBS STANDARD - CPT - 81001",1,24,6.3,2.8,456.36,6]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 72148",1,4633,574.25,254.07,3938.05,1158.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 77067",1,488,177.13,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 64483",1,1545,1074.5899999999999,420.34,1879.97,386.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["AETNA - AETNA MCR SUPP - CPT - J1030",1,13,6.88,4.68,456.36,3.25]
["AETNA - AETNA MCR SUPP - CPT - J3301",1,18,9.52,0.98,456.36,4.5]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 80069",1,195,9.11,7.66,456.36,48.75]
["AETNA - AETNA MCR SUPP - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 72148",1,4633,574.25,254.07,3938.05,1158.25]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["BCBS - BCBS POS - CPT - A9513",1,429,318.61,154.44,456.36,107.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 90662",1,129,73.400000000000006,36.119999999999997,456.36,32.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 90853",1,129,140.56,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85025",1,55,7.77,6.85,456.36,13.75]
["AETNA - AETNA HMO - CPT - 77065",1,752,397.81,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["AETNA - AETNA POS - CPT - 74177",1,3263,1726.13,398.75,2773.55,815.75]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 81001",1,24,6.3,2.8,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["AETNA - AETNA HMO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["AETNA - AETNA POS - CPT - 85027",1,45,23.81,5.71,456.36,11.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - P9047",1,180,55.73,50.13,456.36,45]
["CCA - CCA SCO ONECARE - CPT - 77066",1,924,131.5,131.5,924,231]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 77065",1,752,102.59,102.59,752,188]
["CCA - CCA SCO ONECARE - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CCA - CCA SCO ONECARE - CPT - A9575",1,8,8,0.13,456.36,2]
["CCA - CCA SCO ONECARE - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CCA - CCA SCO STANDARD - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 64483",1,1545,1074.5899999999999,420.34,1879.97,386.25]
["CCA - CCA SCO STANDARD - CPT - 80055",1,260,50.2,18.32,456.36,65]
["BCBS - BCBS POS - CPT - 80076",1,163,16.04,7.21,456.36,40.75]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["AETNA - AETNA POS - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45391",1,2924,1324.99,420.34,2924,731]
["BCBS - BCBS PPO - CPT - 85027",1,45,12.6,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["BCBS - BCBS PPO - CPT - A9575",1,8,8,0.13,456.36,2]
["CCA - ZZZCCA STANDARD - CPT - 77065",1,752,102.59,102.59,752,188]
["BCBS - BCBS SHIP PPO - CPT - 93452",1,6358,5171.1000000000004,420.34,6358,1589.5]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 74177",1,3263,474.98,398.75,2773.55,815.75]
["CCA - ZZZCCA STANDARD - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["AETNA - AETNA PPO EPO - CPT - 77065",1,752,397.81,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 64483",1,1545,1023.42,420.34,1879.97,386.25]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 45380",1,2575,1391.24,420.34,2575,643.75]
["AETNA - AETNA HMO - CPT - 99386",1,640,338.56,23.27,640,160]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["AETNA - AETNA HMO - CPT - A9517",1,523,276.67,20.12,456.36,130.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 80069",1,195,8.68,7.66,456.36,48.75]
["AETNA - AETNA PPO EPO - CPT - A9575",1,8,8,0.13,456.36,2]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - P9047",1,180,53.08,50.13,456.36,45]
["AETNA - AETNA PPO EPO - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 29881",1,5454,2885.17,420.34,5454,1363.5]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 77065",1,752,102.59,102.59,752,188]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["BCBS - BCBS INDEMNITY - CPT - 66821",1,2811,912.96,420.34,2389.35,702.75]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - P9047",1,180,55.73,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77067",1,488,108.47,108.47,488,122]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["AETNA - AETNA STUDENT HEALTH - CPT - 73721",1,5064,2678.86,254.07,4304.3999999999996,1266]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - P9047",1,180,55.73,50.13,456.36,45]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["CIGNA - CIGNA CARELINK - CPT - A9513",1,429,308.05,154.44,456.36,107.25]
["CIGNA - CIGNA CARELINK - CPT - P9047",1,180,57.24,50.13,456.36,45]
["BCBS - BCBS INDEMNITY - CPT - A9575",1,8,8,0.13,456.36,2]
["CIGNA - CIGNA LOCALPLUS - CPT - 66821",1,2811,2389.35,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81001",1,24,3.17,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["CIGNA - CIGNA LOCALPLUS - CPT - 85027",1,45,7.16,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 84153",1,125,18.39,13.26,456.36,31.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 90853",1,129,68.239999999999995,15.63,456.36,32.25]
["CIGNA - CIGNA LOCALPLUS - CPT - A9513",1,429,364.65,154.44,456.36,107.25]
["BCBS - BCBS POS - CPT - 80069",1,195,17.18,7.66,456.36,48.75]
["CIGNA - CIGNA STANDARD - CPT - 43239",1,1712,1455.2,420.34,1871.88,428]
["CIGNA - CIGNA STANDARD - CPT - 66821",1,2811,2389.35,420.34,2389.35,702.75]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CIGNA - CIGNA STANDARD - CPT - 84443",1,114,18.57,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["AETNA - AETNA STUDENT HEALTH - CPT - J3301",1,18,9.52,0.98,456.36,4.5]
["BCBS - BCBS PPO - CPT - 85025",1,55,15.47,6.85,456.36,13.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["BCBS - BCBS PPO - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 80055",1,260,50.2,18.32,456.36,65]
["BCBS - BCBS SHIP PPO - CPT - 64483",1,1545,1407.29,420.34,1879.97,386.25]
["BCBS - BCBS SHIP PPO - CPT - 80055",1,260,93.94,18.32,456.36,65]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["BCBS - BCBS SHIP PPO - CPT - A9513",1,429,318.61,154.44,456.36,107.25]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 80069",1,195,9.5500000000000007,7.66,456.36,48.75]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 90853",1,129,110.09,15.63,456.36,32.25]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 77065",1,752,102.59,102.59,752,188]
["BCBS - BCBS STANDARD - CPT - 66821",1,2811,912.96,420.34,2389.35,702.75]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 77067",1,488,108.47,108.47,488,122]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - J1030",1,13,13,4.68,456.36,3.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["BCBS - BCBS STANDARD - CPT - 90846",1,308,234.69,30.9,456.36,77]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 81001",1,24,3.33,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - J1030",1,13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9517",1,523,21.34,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 90846",1,308,187.97,30.9,456.36,77]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 77065",1,752,102.59,102.59,752,188]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 72193",1,3040,216.61,190.5,2584,760]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 90832",1,168,187.97,21.97,456.36,42]
["BCBS - BCBS HMO - CPT - 77067",1,488,177.13,108.47,488,122]
["AETNA - AETNA HMO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - P9047",1,180,55.73,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["BCBS - BCBS HMO - CPT - 84443",1,114,33.22,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 73721",1,5064,275.13,254.07,4304.3999999999996,1266]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 72193",1,3040,216.61,190.5,2584,760]
["AETNA - AETNA HMO - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["AETNA - AETNA HMO - CPT - J3301",1,18,9.52,0.98,456.36,4.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 77066",1,924,131.5,131.5,924,231]
["BCBS - BCBS HMO - CPT - 85027",1,45,12.6,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 19120",1,4199,4279.8500000000004,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 77065",1,752,102.59,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 77066",1,924,131.5,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 77067",1,488,108.47,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 80055",1,260,47.81,18.32,456.36,65]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80069",1,195,9.11,7.66,456.36,48.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 80061",1,129,13.39,11.81,456.36,32.25]
["BCBS - BCBS HMO - CPT - 90662",1,129,73.400000000000006,36.119999999999997,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 66821",1,2811,685.29,420.34,2389.35,702.75]
["BCBS - BCBS HMO - CPT - 90686",1,74,22.35,19.16,456.36,18.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["BCBS - BCBS HMO - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 72193",1,3040,216.61,190.5,2584,760]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 81001",1,24,3.17,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 77065",1,752,102.59,102.59,752,188]
["BCBS - BCBS HMO - CPT - 90832",1,168,234.69,21.97,456.36,42]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 77067",1,488,108.47,108.47,488,122]
["BCBS - BCBS HMO - CPT - 90834",1,215,234.69,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 84443",1,114,16.8,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90846",1,308,187.97,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 85027",1,45,6.47,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["BCBS - BCBS HMO - CPT - 90837",1,215,234.69,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["BCBS - BCBS HMO - CPT - 90846",1,308,234.69,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["BCBS - BCBS HMO - CPT - 90847",1,363,234.69,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80061",1,129,13.39,11.81,456.36,32.25]
["BCBS - BCBS HMO - CPT - 90853",1,129,140.56,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90686",1,74,20.72,19.16,456.36,18.5]
["BCBS - BCBS HMO - CPT - 93452",1,6358,5171.1000000000004,420.34,6358,1589.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90832",1,168,179.02,21.97,456.36,42]
["BCBS - BCBS HMO - CPT - 95810",1,3935,1679.52,420.34,3344.75,983.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["BCBS - BCBS HMO - CPT - 97110",1,249,83.91,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90837",1,215,179.02,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - J1030",1,13,13,4.68,456.36,3.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - P9047",1,180,55.73,50.13,456.36,45]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90846",1,308,179.02,30.9,456.36,77]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9575",1,8,8,0.13,456.36,2]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 90847",1,363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43235",1,1505,1017.81,420.34,1871.88,376.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - J1030",1,13,13,4.68,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 45380",1,2575,1391.24,420.34,2575,643.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - P9047",1,180,55.73,50.13,456.36,45]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 95810",1,3935,1173.94,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 64483",1,1545,1074.5899999999999,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43239",1,1712,1017.81,420.34,1871.88,428]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 66984",1,2224,2747.38,420.34,4241.13,556]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 97110",1,249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["AETNA - AETNA MCR SUPP - CPT - 19120",1,4199,2221.27,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["AETNA - AETNA MCR SUPP - CPT - 43235",1,1505,796.15,420.34,1871.88,376.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 43239",1,1712,1068.7,420.34,1871.88,428]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 77066",1,924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 45380",1,2575,1391.24,420.34,2575,643.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 80069",1,195,9.11,7.66,456.36,48.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 45391",1,2924,1391.24,420.34,2924,731]
["AETNA - AETNA MCR SUPP - CPT - 43239",1,1712,905.65,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45385",1,3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81001",1,24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45391",1,2924,1324.99,420.34,2924,731]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 64483",1,1545,1074.5899999999999,420.34,1879.97,386.25]
["AETNA - AETNA MCR SUPP - CPT - 45385",1,3040,1608.16,420.34,2929.62,760]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 66821",1,2811,685.29,420.34,2389.35,702.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 66984",1,2224,2747.38,420.34,4241.13,556]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90846",1,308,187.97,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 74177",1,3263,431.8,398.75,2773.55,815.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 72148",1,4633,288.89,254.07,3938.05,1158.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9513",1,429,290.44,154.44,456.36,107.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 72193",1,3040,216.61,190.5,2584,760]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 73721",1,5064,288.89,254.07,4304.3999999999996,1266]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - A9581",1,99,99,15.3,456.36,24.75]
["BCBS - BCBS HMO - CPT - 99385",1,530,342.38,23.27,530,132.5]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["BCBS - BCBS HMO - CPT - 99386",1,640,413.44,23.27,640,160]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["BCBS - BCBS HMO - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 77065",1,752,102.59,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 77066",1,924,131.5,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 77067",1,488,108.47,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80048",1,167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - Q9966",1,1,1,0.36,456.36,0.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 19120",1,4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80055",1,260,50.2,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 43235",1,1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80069",1,195,9.11,7.66,456.36,48.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 45385",1,3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80069",1,195,8.68,7.66,456.36,48.75]
["BCBS - BCBS HMO - CPT - A9513",1,429,318.61,154.44,456.36,107.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 62323",1,1485,815.3,420.34,1505.24,371.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 66821",1,2811,685.29,420.34,2389.35,702.75]
["BCBS - BCBS HMO - CPT - A9517",1,523,88.64,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 70450",1,2022,129.61000000000001,113.99,1718.7,505.5]
["BCBS - BCBS HMO - CPT - A9552",1,1015,1015,365.4,1015,253.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 72110",1,595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 84153",1,125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 72193",1,3040,216.61,190.5,2584,760]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 74177",1,3263,453.39,398.75,2773.55,815.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 85025",1,55,8.16,6.85,456.36,13.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 29881",1,5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 77065",1,752,102.59,102.59,752,188]
["BCBS - BCBS HMO - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 77067",1,488,108.47,108.47,488,122]
["BCBS - BCBS HMO - CPT - A9575",1,8,8,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 80053",1,271,11.09,9.31,456.36,67.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90715",1,180,180,39.75,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 80061",1,129,14.06,11.81,456.36,32.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 80076",1,163,8.58,7.21,456.36,40.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90834",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 81001",1,24,3.33,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 45380",1,2575,1324.99,420.34,2575,643.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90846",1,308,187.97,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 84443",1,114,17.64,14.82,456.36,28.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 85027",1,45,6.79,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 90853",1,129,105.09,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 45391",1,2924,1324.99,420.34,2924,731]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 90832",1,168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 95810",1,3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 90837",1,215,187.97,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 90847",1,363,187.97,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 93452",1,6358,768.9,420.34,6358,1589.5]
["BCBS - BCBS HMO - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 97110",1,249,33.72,23.1,456.36,62.25]
["BCBS - BCBS HMO - CPT - J1030",1,13,9.33,4.68,456.36,3.25]
["AETNA - AETNA MCR SUPP - CPT - 66821",1,2811,1487.02,420.34,2389.35,702.75]
["BCBS - BCBS HMO - CPT - J3301",1,18,18,0.98,456.36,4.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 64483",1,1545,1023.42,420.34,1879.97,386.25]
["BCBS - BCBS HMO - CPT - P9047",1,180,53.08,50.13,456.36,45]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 66984",1,2224,2616.5500000000002,420.34,4241.13,556]
["BCBS - BCBS HMO - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62323",1,1485,776.47,420.34,1505.24,371.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - A9500",1,357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9555",1,1385,1385,420.34,1385,346.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - A9513",1,429,304.95999999999998,154.44,456.36,107.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - A9517",1,523,22.41,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9581",1,99,99,15.3,456.36,24.75]
["CIGNA - CIGNA CARELINK - CPT - 84153",1,125,50.31,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - J3301",1,18,18,0.98,456.36,4.5]
["CIGNA - CIGNA CARELINK - CPT - 84443",1,114,45.94,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - Q9958",1,1,1,0.09,456.36,0.25]
["CIGNA - CIGNA CARELINK - CPT - 85025",1,55,21.26,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 19120",1,4199,4279.8500000000004,420.34,6229.57,1049.75]
["CIGNA - CIGNA CARELINK - CPT - 85027",1,45,17.690000000000001,5.71,456.36,11.25]

{"sheet":"Average Table - CPT","index":14,"n_rows":25514,"n_cols":13,"rows_kept":2250,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
["Payer - Plan - Bill Type - Bill Code","Payer - Plan -Bill Code - Description","Payer","Plan","Bill Type","Bill Code","Bill Code Description","Bill Code & Description","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge"]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 19120 - PR EXCISE BREAST CYST","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 66821 - PR DISCISSION,2ND CATARACT,LASER","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72148 - CHG MRI, LUMBAR SPINE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80055 - CHG OBSTETRIC PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80061 - CHG LIPID PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80069 - CHG RENAL FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 80076 - CHG HEPATIC FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 84443 - CHG ASSAY THYROID STIM HORMONE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85027 - CHG COMPLETE CBC","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90715 - PR TDAP VACCINE >7 YO, IM","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 90853 - PR GROUP PSYCHOTHERAPY","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 97110 - PR THERAPEUTIC EXERCISES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9500 - PR TC99M SESTAMIBI","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9513 - DELETED 2077","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9517 - PR I131 IODIDE CAP, RX","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9552 - PR F18 FDG","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9555 - PR RB82 RUBIDIUM","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9581 - PR GADOXETATE DISODIUM INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 19120 - PR EXCISE BREAST CYST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 66821 - PR DISCISSION,2ND CATARACT,LASER","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72148 - CHG MRI, LUMBAR SPINE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80055 - CHG OBSTETRIC PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80061 - CHG LIPID PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80069 - CHG RENAL FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 80076 - CHG HEPATIC FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 84443 - CHG ASSAY THYROID STIM HORMONE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85027 - CHG COMPLETE CBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90715 - PR TDAP VACCINE >7 YO, IM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 90853 - PR GROUP PSYCHOTHERAPY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 97110 - PR THERAPEUTIC EXERCISES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9500 - PR TC99M SESTAMIBI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9513 - DELETED 2077","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9517 - PR I131 IODIDE CAP, RX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9552 - PR F18 FDG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9555 - PR RB82 RUBIDIUM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - A9581 - PR GADOXETATE DISODIUM INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 19120 - PR EXCISE BREAST CYST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 66821 - PR DISCISSION,2ND CATARACT,LASER","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72148 - CHG MRI, LUMBAR SPINE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80055 - CHG OBSTETRIC PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80061 - CHG LIPID PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80069 - CHG RENAL FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 80076 - CHG HEPATIC FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 84443 - CHG ASSAY THYROID STIM HORMONE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85027 - CHG COMPLETE CBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90715 - PR TDAP VACCINE >7 YO, IM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 90853 - PR GROUP PSYCHOTHERAPY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 97110 - PR THERAPEUTIC EXERCISES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9500 - PR TC99M SESTAMIBI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9513 - DELETED 2077","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9517 - PR I131 IODIDE CAP, RX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9552 - PR F18 FDG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9555 - PR RB82 RUBIDIUM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - A9581 - PR GADOXETATE DISODIUM INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 19120","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 19120 - PR EXCISE BREAST CYST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 29881","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43235","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 43239","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45378","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45380","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45385","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 45391","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 55700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62322","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 62323","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 64483","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 66821","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 66821 - PR DISCISSION,2ND CATARACT,LASER","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 66984","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70450","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 70553","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 70553 - CHG MRI BRAIN COMBO","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72148","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72148 - CHG MRI, LUMBAR SPINE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 72193","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 73721","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 74177","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76700","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76805","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 76830","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77065","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77066","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 77067","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80048","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80053","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80055","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80055 - CHG OBSTETRIC PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80061","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80061 - CHG LIPID PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,13.39,11.81,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80069","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80069 - CHG RENAL FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 80076","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 80076 - CHG HEPATIC FUNCTION PANEL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81000","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81002","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 81003","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.25,1.63,456.36,4.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 84153","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 84443","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 84443 - CHG ASSAY THYROID STIM HORMONE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85025","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85027","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85027 - CHG COMPLETE CBC","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.47,5.71,456.36,11.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85610","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85610 - CHG PROTHROMBIN TIME","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.29,3.58,456.36,7.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 85730","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90662","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90686","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90715","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90715 - PR TDAP VACCINE >7 YO, IM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90832","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90834","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90837","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90846","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90847","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 90853","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 90853 - PR GROUP PSYCHOTHERAPY","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 93452","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 95810","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1173.94,420.34,3344.75,983.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 97110","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 97110 - PR THERAPEUTIC EXERCISES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99203","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99204","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99205","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,148.41999999999999,23.27,899,224.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99212","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99213","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99214","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - 99215","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,148.41999999999999,23.27,595,148.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9500","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9500 - PR TC99M SESTAMIBI","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9513","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9513 - DELETED 2077","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9517","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9517 - PR I131 IODIDE CAP, RX","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,21.34,20.12,456.36,130.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9552","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9552 - PR F18 FDG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9555","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9555 - PR RB82 RUBIDIUM","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9575","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9579","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - A9581","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - A9581 - PR GADOXETATE DISODIUM INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - J1030","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - P9047","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9958","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9963","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9966","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - CPT - Q9967","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - 19120","AETNA - AETNA HMO - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA HMO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA HMO - CPT - 29881","AETNA - AETNA HMO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA HMO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA HMO - CPT - 43235","AETNA - AETNA HMO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA HMO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA HMO - CPT - 43239","AETNA - AETNA HMO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA HMO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA HMO - CPT - 45378","AETNA - AETNA HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA HMO - CPT - 45378","AETNA - AETNA HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA HMO - CPT - 45378","AETNA - AETNA HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA HMO - CPT - 45380","AETNA - AETNA HMO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA HMO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA HMO - CPT - 45385","AETNA - AETNA HMO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA HMO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA HMO - CPT - 45391","AETNA - AETNA HMO - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA HMO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA HMO - CPT - 55700","AETNA - AETNA HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA HMO - CPT - 55700","AETNA - AETNA HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA HMO - CPT - 62322","AETNA - AETNA HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA HMO - CPT - 62322","AETNA - AETNA HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA HMO - CPT - 62323","AETNA - AETNA HMO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA HMO - CPT - 64483","AETNA - AETNA HMO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA HMO - CPT - 66821","AETNA - AETNA HMO - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA HMO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA HMO - CPT - 66984","AETNA - AETNA HMO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA HMO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA HMO - CPT - 70450","AETNA - AETNA HMO - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA HMO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA HMO - CPT - 70553","AETNA - AETNA HMO - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA HMO - CPT - 70553","AETNA - AETNA HMO - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA HMO - CPT - 72110","AETNA - AETNA HMO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA HMO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA HMO - CPT - 72148","AETNA - AETNA HMO - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA HMO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA HMO - CPT - 72193","AETNA - AETNA HMO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA HMO - CPT - 73721","AETNA - AETNA HMO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA HMO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA HMO - CPT - 74177","AETNA - AETNA HMO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA HMO - CPT - 76700","AETNA - AETNA HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA HMO - CPT - 76700","AETNA - AETNA HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA HMO - CPT - 76805","AETNA - AETNA HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA HMO - CPT - 76805","AETNA - AETNA HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA HMO - CPT - 76830","AETNA - AETNA HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA HMO - CPT - 76830","AETNA - AETNA HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA HMO - CPT - 77065","AETNA - AETNA HMO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA HMO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA HMO - CPT - 77066","AETNA - AETNA HMO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA HMO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA HMO - CPT - 77067","AETNA - AETNA HMO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA HMO - CPT - 80048","AETNA - AETNA HMO - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA HMO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA HMO - CPT - 80053","AETNA - AETNA HMO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA HMO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA HMO - CPT - 80055","AETNA - AETNA HMO - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA HMO - CPT - 80061","AETNA - AETNA HMO - 80061 - CHG LIPID PANEL","AETNA","AETNA HMO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA HMO - CPT - 80069","AETNA - AETNA HMO - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA HMO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA HMO - CPT - 80076","AETNA - AETNA HMO - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA HMO - CPT - 81000","AETNA - AETNA HMO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA HMO - CPT - 81000","AETNA - AETNA HMO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA HMO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA HMO - CPT - 81001","AETNA - AETNA HMO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA HMO - CPT - 81002","AETNA - AETNA HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA HMO - CPT - 81002","AETNA - AETNA HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA HMO - CPT - 81003","AETNA - AETNA HMO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA HMO - CPT - 81003","AETNA - AETNA HMO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA HMO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA HMO - CPT - 84153","AETNA - AETNA HMO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA HMO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA HMO - CPT - 84443","AETNA - AETNA HMO - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA HMO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA HMO - CPT - 85025","AETNA - AETNA HMO - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA HMO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA HMO - CPT - 85027","AETNA - AETNA HMO - 85027 - CHG COMPLETE CBC","AETNA","AETNA HMO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA HMO - CPT - 85610","AETNA - AETNA HMO - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA HMO - CPT - 85610","AETNA - AETNA HMO - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA HMO - CPT - 85730","AETNA - AETNA HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA HMO - CPT - 85730","AETNA - AETNA HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA HMO - CPT - 90662","AETNA - AETNA HMO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA HMO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA HMO - CPT - 90686","AETNA - AETNA HMO - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA HMO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA HMO - CPT - 90715","AETNA - AETNA HMO - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA HMO - CPT - 90832","AETNA - AETNA HMO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA HMO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA HMO - CPT - 90834","AETNA - AETNA HMO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA HMO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA HMO - CPT - 90837","AETNA - AETNA HMO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA HMO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA HMO - CPT - 90846","AETNA - AETNA HMO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA HMO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA HMO - CPT - 90847","AETNA - AETNA HMO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA HMO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA HMO - CPT - 90853","AETNA - AETNA HMO - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA HMO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA HMO - CPT - 93452","AETNA - AETNA HMO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA HMO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA HMO - CPT - 95810","AETNA - AETNA HMO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA HMO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA HMO - CPT - 97110","AETNA - AETNA HMO - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA HMO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA HMO - CPT - 99203","AETNA - AETNA HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA HMO - CPT - 99203","AETNA - AETNA HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA HMO - CPT - 99204","AETNA - AETNA HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA HMO - CPT - 99204","AETNA - AETNA HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA HMO - CPT - 99205","AETNA - AETNA HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA HMO - CPT - 99205","AETNA - AETNA HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA HMO - CPT - 99212","AETNA - AETNA HMO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA HMO - CPT - 99212","AETNA - AETNA HMO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA HMO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA HMO - CPT - 99213","AETNA - AETNA HMO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA HMO - CPT - 99213","AETNA - AETNA HMO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA HMO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA HMO - CPT - 99214","AETNA - AETNA HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA HMO - CPT - 99214","AETNA - AETNA HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA HMO - CPT - 99215","AETNA - AETNA HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA HMO - CPT - 99215","AETNA - AETNA HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA HMO - CPT - 99385","AETNA - AETNA HMO - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA HMO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA HMO - CPT - 99386","AETNA - AETNA HMO - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA HMO","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA HMO - CPT - A9500","AETNA - AETNA HMO - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA HMO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AETNA - AETNA HMO - CPT - A9513","AETNA - AETNA HMO - A9513 - DELETED 2077","AETNA","AETNA HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25]
["AETNA - AETNA HMO - CPT - A9517","AETNA - AETNA HMO - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA HMO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA HMO - CPT - A9552","AETNA - AETNA HMO - A9552 - PR F18 FDG","AETNA","AETNA HMO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AETNA - AETNA HMO - CPT - A9555","AETNA - AETNA HMO - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA HMO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AETNA - AETNA HMO - CPT - A9575","AETNA - AETNA HMO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA HMO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AETNA - AETNA HMO - CPT - A9579","AETNA - AETNA HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AETNA - AETNA HMO - CPT - A9579","AETNA - AETNA HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AETNA - AETNA HMO - CPT - A9581","AETNA - AETNA HMO - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA HMO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AETNA - AETNA HMO - CPT - J1030","AETNA - AETNA HMO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA HMO - CPT - J3301","AETNA - AETNA HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA HMO - CPT - P9047","AETNA - AETNA HMO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA HMO - CPT - Q9958","AETNA - AETNA HMO - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA HMO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9963","AETNA - AETNA HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9963","AETNA - AETNA HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9966","AETNA - AETNA HMO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA HMO - CPT - Q9967","AETNA - AETNA HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - 19120","AETNA - AETNA MCR SUPP - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA MCR SUPP","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA MCR SUPP - CPT - 29881","AETNA - AETNA MCR SUPP - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA MCR SUPP","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA MCR SUPP - CPT - 43235","AETNA - AETNA MCR SUPP - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA MCR SUPP","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA MCR SUPP - CPT - 43239","AETNA - AETNA MCR SUPP - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA MCR SUPP","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA - AETNA MCR SUPP - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA - AETNA MCR SUPP - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA MCR SUPP - CPT - 45378","AETNA - AETNA MCR SUPP - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA MCR SUPP","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA MCR SUPP - CPT - 45380","AETNA - AETNA MCR SUPP - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA MCR SUPP","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA MCR SUPP - CPT - 45385","AETNA - AETNA MCR SUPP - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA MCR SUPP","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA MCR SUPP - CPT - 45391","AETNA - AETNA MCR SUPP - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA MCR SUPP","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA MCR SUPP - CPT - 55700","AETNA - AETNA MCR SUPP - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA MCR SUPP","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA MCR SUPP - CPT - 55700","AETNA - AETNA MCR SUPP - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA MCR SUPP","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA MCR SUPP - CPT - 62322","AETNA - AETNA MCR SUPP - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA MCR SUPP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA MCR SUPP - CPT - 62322","AETNA - AETNA MCR SUPP - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA MCR SUPP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA MCR SUPP - CPT - 62323","AETNA - AETNA MCR SUPP - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA MCR SUPP","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA MCR SUPP - CPT - 64483","AETNA - AETNA MCR SUPP - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA MCR SUPP","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA MCR SUPP - CPT - 66821","AETNA - AETNA MCR SUPP - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA MCR SUPP","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA MCR SUPP - CPT - 66984","AETNA - AETNA MCR SUPP - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA MCR SUPP","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA MCR SUPP - CPT - 70450","AETNA - AETNA MCR SUPP - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA MCR SUPP","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA MCR SUPP - CPT - 70553","AETNA - AETNA MCR SUPP - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA MCR SUPP","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA MCR SUPP - CPT - 70553","AETNA - AETNA MCR SUPP - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA MCR SUPP","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA MCR SUPP - CPT - 72110","AETNA - AETNA MCR SUPP - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA MCR SUPP","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA MCR SUPP - CPT - 72148","AETNA - AETNA MCR SUPP - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA MCR SUPP","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA MCR SUPP - CPT - 72193","AETNA - AETNA MCR SUPP - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA MCR SUPP","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA MCR SUPP - CPT - 73721","AETNA - AETNA MCR SUPP - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA MCR SUPP","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA MCR SUPP - CPT - 74177","AETNA - AETNA MCR SUPP - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA MCR SUPP","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA MCR SUPP - CPT - 76700","AETNA - AETNA MCR SUPP - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA MCR SUPP","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA MCR SUPP - CPT - 76700","AETNA - AETNA MCR SUPP - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA MCR SUPP","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA MCR SUPP - CPT - 76805","AETNA - AETNA MCR SUPP - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA MCR SUPP","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA MCR SUPP - CPT - 76805","AETNA - AETNA MCR SUPP - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA MCR SUPP","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA MCR SUPP - CPT - 76830","AETNA - AETNA MCR SUPP - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA MCR SUPP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA MCR SUPP - CPT - 76830","AETNA - AETNA MCR SUPP - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA MCR SUPP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA MCR SUPP - CPT - 77065","AETNA - AETNA MCR SUPP - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA MCR SUPP","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA MCR SUPP - CPT - 77066","AETNA - AETNA MCR SUPP - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA MCR SUPP","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA MCR SUPP - CPT - 77067","AETNA - AETNA MCR SUPP - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA MCR SUPP","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA MCR SUPP - CPT - 80048","AETNA - AETNA MCR SUPP - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA MCR SUPP","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA MCR SUPP - CPT - 80053","AETNA - AETNA MCR SUPP - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA MCR SUPP","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA MCR SUPP - CPT - 80055","AETNA - AETNA MCR SUPP - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA MCR SUPP","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA MCR SUPP - CPT - 80061","AETNA - AETNA MCR SUPP - 80061 - CHG LIPID PANEL","AETNA","AETNA MCR SUPP","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA MCR SUPP - CPT - 80069","AETNA - AETNA MCR SUPP - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA MCR SUPP","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA MCR SUPP - CPT - 80076","AETNA - AETNA MCR SUPP - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA MCR SUPP","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA MCR SUPP - CPT - 81000","AETNA - AETNA MCR SUPP - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA MCR SUPP","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA MCR SUPP - CPT - 81000","AETNA - AETNA MCR SUPP - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA MCR SUPP","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA MCR SUPP - CPT - 81001","AETNA - AETNA MCR SUPP - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA MCR SUPP","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA MCR SUPP - CPT - 81002","AETNA - AETNA MCR SUPP - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA MCR SUPP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA MCR SUPP - CPT - 81002","AETNA - AETNA MCR SUPP - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA MCR SUPP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA MCR SUPP - CPT - 81003","AETNA - AETNA MCR SUPP - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA MCR SUPP","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA MCR SUPP - CPT - 81003","AETNA - AETNA MCR SUPP - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA MCR SUPP","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA MCR SUPP - CPT - 84153","AETNA - AETNA MCR SUPP - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA MCR SUPP","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA MCR SUPP - CPT - 84443","AETNA - AETNA MCR SUPP - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA MCR SUPP","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA MCR SUPP - CPT - 85025","AETNA - AETNA MCR SUPP - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA MCR SUPP","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA MCR SUPP - CPT - 85027","AETNA - AETNA MCR SUPP - 85027 - CHG COMPLETE CBC","AETNA","AETNA MCR SUPP","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA MCR SUPP - CPT - 85610","AETNA - AETNA MCR SUPP - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA MCR SUPP","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA MCR SUPP - CPT - 85610","AETNA - AETNA MCR SUPP - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA MCR SUPP","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA MCR SUPP - CPT - 85730","AETNA - AETNA MCR SUPP - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA MCR SUPP","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA MCR SUPP - CPT - 85730","AETNA - AETNA MCR SUPP - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA MCR SUPP","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA MCR SUPP - CPT - 90662","AETNA - AETNA MCR SUPP - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA MCR SUPP","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA MCR SUPP - CPT - 90686","AETNA - AETNA MCR SUPP - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA MCR SUPP","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA MCR SUPP - CPT - 90715","AETNA - AETNA MCR SUPP - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA MCR SUPP","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA MCR SUPP - CPT - 90832","AETNA - AETNA MCR SUPP - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA MCR SUPP","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA MCR SUPP - CPT - 90834","AETNA - AETNA MCR SUPP - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA MCR SUPP","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA MCR SUPP - CPT - 90837","AETNA - AETNA MCR SUPP - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA MCR SUPP","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA MCR SUPP - CPT - 90846","AETNA - AETNA MCR SUPP - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA MCR SUPP","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA MCR SUPP - CPT - 90847","AETNA - AETNA MCR SUPP - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA MCR SUPP","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA MCR SUPP - CPT - 90853","AETNA - AETNA MCR SUPP - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA MCR SUPP","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA MCR SUPP - CPT - 93452","AETNA - AETNA MCR SUPP - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA MCR SUPP","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA MCR SUPP - CPT - 95810","AETNA - AETNA MCR SUPP - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA MCR SUPP","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA MCR SUPP - CPT - 97110","AETNA - AETNA MCR SUPP - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA MCR SUPP","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA MCR SUPP - CPT - 99203","AETNA - AETNA MCR SUPP - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA MCR SUPP","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA MCR SUPP - CPT - 99203","AETNA - AETNA MCR SUPP - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA MCR SUPP","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA MCR SUPP - CPT - 99204","AETNA - AETNA MCR SUPP - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA MCR SUPP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA MCR SUPP - CPT - 99204","AETNA - AETNA MCR SUPP - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA MCR SUPP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA MCR SUPP - CPT - 99205","AETNA - AETNA MCR SUPP - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA MCR SUPP","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA MCR SUPP - CPT - 99205","AETNA - AETNA MCR SUPP - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA MCR SUPP","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA MCR SUPP - CPT - 99212","AETNA - AETNA MCR SUPP - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA MCR SUPP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA MCR SUPP - CPT - 99212","AETNA - AETNA MCR SUPP - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA MCR SUPP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA MCR SUPP - CPT - 99213","AETNA - AETNA MCR SUPP - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA MCR SUPP","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA MCR SUPP - CPT - 99213","AETNA - AETNA MCR SUPP - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA MCR SUPP","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA MCR SUPP - CPT - 99214","AETNA - AETNA MCR SUPP - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA MCR SUPP","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA MCR SUPP - CPT - 99214","AETNA - AETNA MCR SUPP - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA MCR SUPP","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA MCR SUPP - CPT - 99215","AETNA - AETNA MCR SUPP - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA MCR SUPP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA MCR SUPP - CPT - 99215","AETNA - AETNA MCR SUPP - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA MCR SUPP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA MCR SUPP - CPT - 99385","AETNA - AETNA MCR SUPP - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA MCR SUPP","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA MCR SUPP - CPT - 99386","AETNA - AETNA MCR SUPP - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA MCR SUPP","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA MCR SUPP - CPT - A9500","AETNA - AETNA MCR SUPP - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA MCR SUPP","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AETNA - AETNA MCR SUPP - CPT - A9513","AETNA - AETNA MCR SUPP - A9513 - DELETED 2077","AETNA","AETNA MCR SUPP","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25]
["AETNA - AETNA MCR SUPP - CPT - A9517","AETNA - AETNA MCR SUPP - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA MCR SUPP","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA MCR SUPP - CPT - A9552","AETNA - AETNA MCR SUPP - A9552 - PR F18 FDG","AETNA","AETNA MCR SUPP","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AETNA - AETNA MCR SUPP - CPT - A9555","AETNA - AETNA MCR SUPP - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA MCR SUPP","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AETNA - AETNA MCR SUPP - CPT - A9575","AETNA - AETNA MCR SUPP - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA MCR SUPP","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AETNA - AETNA MCR SUPP - CPT - A9579","AETNA - AETNA MCR SUPP - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA MCR SUPP","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AETNA - AETNA MCR SUPP - CPT - A9579","AETNA - AETNA MCR SUPP - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA MCR SUPP","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AETNA - AETNA MCR SUPP - CPT - A9581","AETNA - AETNA MCR SUPP - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA MCR SUPP","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AETNA - AETNA MCR SUPP - CPT - J1030","AETNA - AETNA MCR SUPP - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA MCR SUPP","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA MCR SUPP - CPT - J3301","AETNA - AETNA MCR SUPP - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA MCR SUPP","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA MCR SUPP - CPT - P9047","AETNA - AETNA MCR SUPP - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA MCR SUPP","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA MCR SUPP - CPT - Q9958","AETNA - AETNA MCR SUPP - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA MCR SUPP","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9963","AETNA - AETNA MCR SUPP - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9963","AETNA - AETNA MCR SUPP - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9966","AETNA - AETNA MCR SUPP - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA MCR SUPP - CPT - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - 19120","AETNA - AETNA POS - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA POS","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA POS - CPT - 29881","AETNA - AETNA POS - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA POS","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA POS - CPT - 43235","AETNA - AETNA POS - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA POS","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA POS - CPT - 43239","AETNA - AETNA POS - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA POS","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA POS - CPT - 45378","AETNA - AETNA POS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA POS - CPT - 45378","AETNA - AETNA POS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA POS - CPT - 45378","AETNA - AETNA POS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA POS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA POS - CPT - 45380","AETNA - AETNA POS - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA POS","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA POS - CPT - 45385","AETNA - AETNA POS - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA POS","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA POS - CPT - 45391","AETNA - AETNA POS - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA POS","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA POS - CPT - 55700","AETNA - AETNA POS - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA POS","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA POS - CPT - 55700","AETNA - AETNA POS - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA POS","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA POS - CPT - 62322","AETNA - AETNA POS - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA POS - CPT - 62322","AETNA - AETNA POS - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA POS - CPT - 62323","AETNA - AETNA POS - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA POS","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA POS - CPT - 64483","AETNA - AETNA POS - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA POS","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA POS - CPT - 66821","AETNA - AETNA POS - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA POS","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA POS - CPT - 66984","AETNA - AETNA POS - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA POS","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA POS - CPT - 70450","AETNA - AETNA POS - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA POS","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA POS - CPT - 70553","AETNA - AETNA POS - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA POS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA POS - CPT - 70553","AETNA - AETNA POS - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA POS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA POS - CPT - 72110","AETNA - AETNA POS - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA POS","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA POS - CPT - 72148","AETNA - AETNA POS - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA POS","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA POS - CPT - 72193","AETNA - AETNA POS - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA POS","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA POS - CPT - 73721","AETNA - AETNA POS - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA POS","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA POS - CPT - 74177","AETNA - AETNA POS - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA POS","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA POS - CPT - 76700","AETNA - AETNA POS - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA POS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA POS - CPT - 76700","AETNA - AETNA POS - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA POS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA POS - CPT - 76805","AETNA - AETNA POS - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA POS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA POS - CPT - 76805","AETNA - AETNA POS - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA POS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA POS - CPT - 76830","AETNA - AETNA POS - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA POS","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA POS - CPT - 76830","AETNA - AETNA POS - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA POS","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA POS - CPT - 77065","AETNA - AETNA POS - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA POS","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA POS - CPT - 77066","AETNA - AETNA POS - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA POS","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA POS - CPT - 77067","AETNA - AETNA POS - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA POS","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA POS - CPT - 80048","AETNA - AETNA POS - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA POS","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA POS - CPT - 80053","AETNA - AETNA POS - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA POS","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA POS - CPT - 80055","AETNA - AETNA POS - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA POS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA POS - CPT - 80061","AETNA - AETNA POS - 80061 - CHG LIPID PANEL","AETNA","AETNA POS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA POS - CPT - 80069","AETNA - AETNA POS - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA POS","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA POS - CPT - 80076","AETNA - AETNA POS - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA POS","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA POS - CPT - 81000","AETNA - AETNA POS - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA POS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA POS - CPT - 81000","AETNA - AETNA POS - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA POS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA POS - CPT - 81001","AETNA - AETNA POS - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA POS","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA POS - CPT - 81002","AETNA - AETNA POS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA POS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA POS - CPT - 81002","AETNA - AETNA POS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA POS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA POS - CPT - 81003","AETNA - AETNA POS - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA POS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA POS - CPT - 81003","AETNA - AETNA POS - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA POS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA POS - CPT - 84153","AETNA - AETNA POS - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA POS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA POS - CPT - 84443","AETNA - AETNA POS - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA POS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA POS - CPT - 85025","AETNA - AETNA POS - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA POS","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA POS - CPT - 85027","AETNA - AETNA POS - 85027 - CHG COMPLETE CBC","AETNA","AETNA POS","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA POS - CPT - 85610","AETNA - AETNA POS - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA POS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA POS - CPT - 85610","AETNA - AETNA POS - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA POS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA POS - CPT - 85730","AETNA - AETNA POS - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA POS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA POS - CPT - 85730","AETNA - AETNA POS - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA POS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA POS - CPT - 90662","AETNA - AETNA POS - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA POS","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA POS - CPT - 90686","AETNA - AETNA POS - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA POS","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA POS - CPT - 90715","AETNA - AETNA POS - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA POS","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA POS - CPT - 90832","AETNA - AETNA POS - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA POS","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA POS - CPT - 90834","AETNA - AETNA POS - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA POS","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA POS - CPT - 90837","AETNA - AETNA POS - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA POS","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA POS - CPT - 90846","AETNA - AETNA POS - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA POS","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA POS - CPT - 90847","AETNA - AETNA POS - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA POS","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA POS - CPT - 90853","AETNA - AETNA POS - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA POS","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA POS - CPT - 93452","AETNA - AETNA POS - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA POS","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA POS - CPT - 95810","AETNA - AETNA POS - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA POS","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA POS - CPT - 97110","AETNA - AETNA POS - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA POS","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA POS - CPT - 99203","AETNA - AETNA POS - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA POS - CPT - 99203","AETNA - AETNA POS - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA POS - CPT - 99204","AETNA - AETNA POS - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA POS","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA POS - CPT - 99204","AETNA - AETNA POS - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA POS","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA POS - CPT - 99205","AETNA - AETNA POS - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA POS - CPT - 99205","AETNA - AETNA POS - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA POS - CPT - 99212","AETNA - AETNA POS - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA POS - CPT - 99212","AETNA - AETNA POS - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA POS - CPT - 99213","AETNA - AETNA POS - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA POS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA POS - CPT - 99213","AETNA - AETNA POS - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA POS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA POS - CPT - 99214","AETNA - AETNA POS - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA POS","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA POS - CPT - 99214","AETNA - AETNA POS - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA POS","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA POS - CPT - 99215","AETNA - AETNA POS - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA POS","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA POS - CPT - 99215","AETNA - AETNA POS - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA POS","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA POS - CPT - 99385","AETNA - AETNA POS - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA POS","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA POS - CPT - 99386","AETNA - AETNA POS - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA POS","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA POS - CPT - A9500","AETNA - AETNA POS - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA POS","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AETNA - AETNA POS - CPT - A9513","AETNA - AETNA POS - A9513 - DELETED 2077","AETNA","AETNA POS","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25]
["AETNA - AETNA POS - CPT - A9517","AETNA - AETNA POS - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA POS","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA POS - CPT - A9552","AETNA - AETNA POS - A9552 - PR F18 FDG","AETNA","AETNA POS","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AETNA - AETNA POS - CPT - A9555","AETNA - AETNA POS - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA POS","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AETNA - AETNA POS - CPT - A9575","AETNA - AETNA POS - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA POS","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AETNA - AETNA POS - CPT - A9579","AETNA - AETNA POS - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AETNA - AETNA POS - CPT - A9579","AETNA - AETNA POS - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AETNA - AETNA POS - CPT - A9581","AETNA - AETNA POS - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA POS","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AETNA - AETNA POS - CPT - J1030","AETNA - AETNA POS - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA POS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA POS - CPT - J3301","AETNA - AETNA POS - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA POS","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA POS - CPT - P9047","AETNA - AETNA POS - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA POS","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA POS - CPT - Q9958","AETNA - AETNA POS - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA POS","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9963","AETNA - AETNA POS - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9963","AETNA - AETNA POS - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9966","AETNA - AETNA POS - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA POS - CPT - Q9967","AETNA - AETNA POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - 19120","AETNA - AETNA PPO EPO - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA PPO EPO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA PPO EPO - CPT - 29881","AETNA - AETNA PPO EPO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA PPO EPO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA PPO EPO - CPT - 43235","AETNA - AETNA PPO EPO - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA PPO EPO","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA PPO EPO - CPT - 43239","AETNA - AETNA PPO EPO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA PPO EPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA - AETNA PPO EPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA - AETNA PPO EPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA PPO EPO - CPT - 45378","AETNA - AETNA PPO EPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA PPO EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["AETNA - AETNA PPO EPO - CPT - 45380","AETNA - AETNA PPO EPO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA PPO EPO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA PPO EPO - CPT - 45385","AETNA - AETNA PPO EPO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA PPO EPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA PPO EPO - CPT - 45391","AETNA - AETNA PPO EPO - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA PPO EPO","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA PPO EPO - CPT - 55700","AETNA - AETNA PPO EPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA PPO EPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA PPO EPO - CPT - 55700","AETNA - AETNA PPO EPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA PPO EPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA PPO EPO - CPT - 62322","AETNA - AETNA PPO EPO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA PPO EPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA PPO EPO - CPT - 62322","AETNA - AETNA PPO EPO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA PPO EPO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA PPO EPO - CPT - 62323","AETNA - AETNA PPO EPO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA PPO EPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA PPO EPO - CPT - 64483","AETNA - AETNA PPO EPO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA PPO EPO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA PPO EPO - CPT - 66821","AETNA - AETNA PPO EPO - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA PPO EPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA PPO EPO - CPT - 66984","AETNA - AETNA PPO EPO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA PPO EPO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA PPO EPO - CPT - 70450","AETNA - AETNA PPO EPO - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA PPO EPO","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA PPO EPO - CPT - 70553","AETNA - AETNA PPO EPO - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA PPO EPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA PPO EPO - CPT - 70553","AETNA - AETNA PPO EPO - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA PPO EPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA PPO EPO - CPT - 72110","AETNA - AETNA PPO EPO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA PPO EPO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA PPO EPO - CPT - 72148","AETNA - AETNA PPO EPO - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA PPO EPO","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA PPO EPO - CPT - 72193","AETNA - AETNA PPO EPO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA PPO EPO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA PPO EPO - CPT - 73721","AETNA - AETNA PPO EPO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA PPO EPO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA PPO EPO - CPT - 74177","AETNA - AETNA PPO EPO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA PPO EPO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA PPO EPO - CPT - 76700","AETNA - AETNA PPO EPO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA PPO EPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA PPO EPO - CPT - 76700","AETNA - AETNA PPO EPO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA PPO EPO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA PPO EPO - CPT - 76805","AETNA - AETNA PPO EPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA PPO EPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA PPO EPO - CPT - 76805","AETNA - AETNA PPO EPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA PPO EPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA PPO EPO - CPT - 76830","AETNA - AETNA PPO EPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA PPO EPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA PPO EPO - CPT - 76830","AETNA - AETNA PPO EPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA PPO EPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA PPO EPO - CPT - 77065","AETNA - AETNA PPO EPO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA PPO EPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA PPO EPO - CPT - 77066","AETNA - AETNA PPO EPO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA PPO EPO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA PPO EPO - CPT - 77067","AETNA - AETNA PPO EPO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA PPO EPO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA PPO EPO - CPT - 80048","AETNA - AETNA PPO EPO - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA PPO EPO","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA PPO EPO - CPT - 80053","AETNA - AETNA PPO EPO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA PPO EPO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA PPO EPO - CPT - 80055","AETNA - AETNA PPO EPO - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA PPO EPO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA PPO EPO - CPT - 80061","AETNA - AETNA PPO EPO - 80061 - CHG LIPID PANEL","AETNA","AETNA PPO EPO","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA PPO EPO - CPT - 80069","AETNA - AETNA PPO EPO - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA PPO EPO","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA PPO EPO - CPT - 80076","AETNA - AETNA PPO EPO - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA PPO EPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA PPO EPO - CPT - 81000","AETNA - AETNA PPO EPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA PPO EPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA PPO EPO - CPT - 81000","AETNA - AETNA PPO EPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA PPO EPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA PPO EPO - CPT - 81001","AETNA - AETNA PPO EPO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA PPO EPO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA PPO EPO - CPT - 81002","AETNA - AETNA PPO EPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA PPO EPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA PPO EPO - CPT - 81002","AETNA - AETNA PPO EPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA PPO EPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA PPO EPO - CPT - 81003","AETNA - AETNA PPO EPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA PPO EPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA PPO EPO - CPT - 81003","AETNA - AETNA PPO EPO - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA PPO EPO","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA PPO EPO - CPT - 84153","AETNA - AETNA PPO EPO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA PPO EPO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA PPO EPO - CPT - 84443","AETNA - AETNA PPO EPO - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA PPO EPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA PPO EPO - CPT - 85025","AETNA - AETNA PPO EPO - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA PPO EPO","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA PPO EPO - CPT - 85027","AETNA - AETNA PPO EPO - 85027 - CHG COMPLETE CBC","AETNA","AETNA PPO EPO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA PPO EPO - CPT - 85610","AETNA - AETNA PPO EPO - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA PPO EPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA PPO EPO - CPT - 85610","AETNA - AETNA PPO EPO - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA PPO EPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA PPO EPO - CPT - 85730","AETNA - AETNA PPO EPO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA PPO EPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA PPO EPO - CPT - 85730","AETNA - AETNA PPO EPO - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA PPO EPO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA PPO EPO - CPT - 90662","AETNA - AETNA PPO EPO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA PPO EPO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA PPO EPO - CPT - 90686","AETNA - AETNA PPO EPO - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA PPO EPO","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA PPO EPO - CPT - 90715","AETNA - AETNA PPO EPO - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA PPO EPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA PPO EPO - CPT - 90832","AETNA - AETNA PPO EPO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA PPO EPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA PPO EPO - CPT - 90834","AETNA - AETNA PPO EPO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA PPO EPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA PPO EPO - CPT - 90837","AETNA - AETNA PPO EPO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA PPO EPO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA PPO EPO - CPT - 90846","AETNA - AETNA PPO EPO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA PPO EPO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA PPO EPO - CPT - 90847","AETNA - AETNA PPO EPO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA PPO EPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA PPO EPO - CPT - 90853","AETNA - AETNA PPO EPO - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA PPO EPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA PPO EPO - CPT - 93452","AETNA - AETNA PPO EPO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA PPO EPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA PPO EPO - CPT - 95810","AETNA - AETNA PPO EPO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA PPO EPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA PPO EPO - CPT - 97110","AETNA - AETNA PPO EPO - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA PPO EPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA PPO EPO - CPT - 99203","AETNA - AETNA PPO EPO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA PPO EPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA PPO EPO - CPT - 99203","AETNA - AETNA PPO EPO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA PPO EPO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA PPO EPO - CPT - 99204","AETNA - AETNA PPO EPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA PPO EPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA PPO EPO - CPT - 99204","AETNA - AETNA PPO EPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA PPO EPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA PPO EPO - CPT - 99205","AETNA - AETNA PPO EPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA PPO EPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA PPO EPO - CPT - 99205","AETNA - AETNA PPO EPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA PPO EPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA PPO EPO - CPT - 99212","AETNA - AETNA PPO EPO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA PPO EPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA PPO EPO - CPT - 99212","AETNA - AETNA PPO EPO - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA PPO EPO","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA PPO EPO - CPT - 99213","AETNA - AETNA PPO EPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA PPO EPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA PPO EPO - CPT - 99213","AETNA - AETNA PPO EPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA PPO EPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA PPO EPO - CPT - 99214","AETNA - AETNA PPO EPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA PPO EPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA PPO EPO - CPT - 99214","AETNA - AETNA PPO EPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA PPO EPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA PPO EPO - CPT - 99215","AETNA - AETNA PPO EPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA PPO EPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA PPO EPO - CPT - 99215","AETNA - AETNA PPO EPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA PPO EPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA PPO EPO - CPT - 99385","AETNA - AETNA PPO EPO - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA PPO EPO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA PPO EPO - CPT - 99386","AETNA - AETNA PPO EPO - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA PPO EPO","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA PPO EPO - CPT - A9500","AETNA - AETNA PPO EPO - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA PPO EPO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["AETNA - AETNA PPO EPO - CPT - A9513","AETNA - AETNA PPO EPO - A9513 - DELETED 2077","AETNA","AETNA PPO EPO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,320.83999999999997,154.44,456.36,107.25]
["AETNA - AETNA PPO EPO - CPT - A9517","AETNA - AETNA PPO EPO - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA PPO EPO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA PPO EPO - CPT - A9552","AETNA - AETNA PPO EPO - A9552 - PR F18 FDG","AETNA","AETNA PPO EPO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["AETNA - AETNA PPO EPO - CPT - A9555","AETNA - AETNA PPO EPO - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA PPO EPO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["AETNA - AETNA PPO EPO - CPT - A9575","AETNA - AETNA PPO EPO - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA PPO EPO","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["AETNA - AETNA PPO EPO - CPT - A9579","AETNA - AETNA PPO EPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA PPO EPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AETNA - AETNA PPO EPO - CPT - A9579","AETNA - AETNA PPO EPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA PPO EPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["AETNA - AETNA PPO EPO - CPT - A9581","AETNA - AETNA PPO EPO - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA PPO EPO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["AETNA - AETNA PPO EPO - CPT - J1030","AETNA - AETNA PPO EPO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA PPO EPO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA PPO EPO - CPT - J3301","AETNA - AETNA PPO EPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA PPO EPO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA PPO EPO - CPT - P9047","AETNA - AETNA PPO EPO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA PPO EPO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA PPO EPO - CPT - Q9958","AETNA - AETNA PPO EPO - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA PPO EPO","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9963","AETNA - AETNA PPO EPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9963","AETNA - AETNA PPO EPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9966","AETNA - AETNA PPO EPO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA PPO EPO - CPT - Q9967","AETNA - AETNA PPO EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA PPO EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - 19120","AETNA - AETNA STUDENT HEALTH - 19120 - PR EXCISE BREAST CYST","AETNA","AETNA STUDENT HEALTH","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 29881","AETNA - AETNA STUDENT HEALTH - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA","AETNA STUDENT HEALTH","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2885.17,420.34,5454,1363.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 43235","AETNA - AETNA STUDENT HEALTH - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA","AETNA STUDENT HEALTH","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,796.15,420.34,1871.88,376.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 43239","AETNA - AETNA STUDENT HEALTH - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA","AETNA STUDENT HEALTH","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,905.65,420.34,1871.88,428]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA - AETNA STUDENT HEALTH - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA - AETNA STUDENT HEALTH - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 45378","AETNA - AETNA STUDENT HEALTH - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA","AETNA STUDENT HEALTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1139.47,395.43,2154,538.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 45380","AETNA - AETNA STUDENT HEALTH - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA","AETNA STUDENT HEALTH","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 45385","AETNA - AETNA STUDENT HEALTH - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA","AETNA STUDENT HEALTH","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1608.16,420.34,2929.62,760]
["AETNA - AETNA STUDENT HEALTH - CPT - 45391","AETNA - AETNA STUDENT HEALTH - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA","AETNA STUDENT HEALTH","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1546.8,420.34,2924,731]
["AETNA - AETNA STUDENT HEALTH - CPT - 55700","AETNA - AETNA STUDENT HEALTH - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA STUDENT HEALTH","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA STUDENT HEALTH - CPT - 55700","AETNA - AETNA STUDENT HEALTH - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA","AETNA STUDENT HEALTH","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1242.0899999999999,420.34,3848.68,587]
["AETNA - AETNA STUDENT HEALTH - CPT - 62322","AETNA - AETNA STUDENT HEALTH - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA STUDENT HEALTH","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 62322","AETNA - AETNA STUDENT HEALTH - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA","AETNA STUDENT HEALTH","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 62323","AETNA - AETNA STUDENT HEALTH - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA","AETNA STUDENT HEALTH","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,785.57,420.34,1505.24,371.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 64483","AETNA - AETNA STUDENT HEALTH - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA","AETNA STUDENT HEALTH","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 66821","AETNA - AETNA STUDENT HEALTH - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA","AETNA STUDENT HEALTH","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1487.02,420.34,2389.35,702.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 66984","AETNA - AETNA STUDENT HEALTH - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA","AETNA STUDENT HEALTH","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1176.5,420.34,4241.13,556]
["AETNA - AETNA STUDENT HEALTH - CPT - 70450","AETNA - AETNA STUDENT HEALTH - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA","AETNA STUDENT HEALTH","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,1069.6400000000001,113.99,1718.7,505.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 70553","AETNA - AETNA STUDENT HEALTH - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA STUDENT HEALTH","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 70553","AETNA - AETNA STUDENT HEALTH - 70553 - CHG MRI BRAIN COMBO","AETNA","AETNA STUDENT HEALTH","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3659.09,398.75,5879.45,1729.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 72110","AETNA - AETNA STUDENT HEALTH - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA","AETNA STUDENT HEALTH","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,314.76,46.45,595,148.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 72148","AETNA - AETNA STUDENT HEALTH - 72148 - CHG MRI, LUMBAR SPINE","AETNA","AETNA STUDENT HEALTH","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,2450.86,254.07,3938.05,1158.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 72193","AETNA - AETNA STUDENT HEALTH - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA","AETNA STUDENT HEALTH","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,1608.16,190.5,2584,760]
["AETNA - AETNA STUDENT HEALTH - CPT - 73721","AETNA - AETNA STUDENT HEALTH - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA","AETNA STUDENT HEALTH","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["AETNA - AETNA STUDENT HEALTH - CPT - 74177","AETNA - AETNA STUDENT HEALTH - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA","AETNA STUDENT HEALTH","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,1726.13,398.75,2773.55,815.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 76700","AETNA - AETNA STUDENT HEALTH - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA STUDENT HEALTH","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 76700","AETNA - AETNA STUDENT HEALTH - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","AETNA","AETNA STUDENT HEALTH","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,598.29999999999995,111.92,961.35,282.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 76805","AETNA - AETNA STUDENT HEALTH - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA STUDENT HEALTH","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA STUDENT HEALTH - CPT - 76805","AETNA - AETNA STUDENT HEALTH - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","AETNA","AETNA STUDENT HEALTH","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,630.57000000000005,113.99,1013.2,298]
["AETNA - AETNA STUDENT HEALTH - CPT - 76830","AETNA - AETNA STUDENT HEALTH - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA STUDENT HEALTH - CPT - 76830","AETNA - AETNA STUDENT HEALTH - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","AETNA","AETNA STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["AETNA - AETNA STUDENT HEALTH - CPT - 77065","AETNA - AETNA STUDENT HEALTH - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","AETNA","AETNA STUDENT HEALTH","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["AETNA - AETNA STUDENT HEALTH - CPT - 77066","AETNA - AETNA STUDENT HEALTH - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","AETNA","AETNA STUDENT HEALTH","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,488.8,131.5,924,231]
["AETNA - AETNA STUDENT HEALTH - CPT - 77067","AETNA - AETNA STUDENT HEALTH - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","AETNA","AETNA STUDENT HEALTH","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,258.14999999999998,108.47,488,122]
["AETNA - AETNA STUDENT HEALTH - CPT - 80048","AETNA - AETNA STUDENT HEALTH - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA","AETNA STUDENT HEALTH","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,88.34,7.46,456.36,41.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 80053","AETNA - AETNA STUDENT HEALTH - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","AETNA","AETNA STUDENT HEALTH","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,143.36000000000001,9.31,456.36,67.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 80055","AETNA - AETNA STUDENT HEALTH - 80055 - CHG OBSTETRIC PANEL","AETNA","AETNA STUDENT HEALTH","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,137.54,18.32,456.36,65]
["AETNA - AETNA STUDENT HEALTH - CPT - 80061","AETNA - AETNA STUDENT HEALTH - 80061 - CHG LIPID PANEL","AETNA","AETNA STUDENT HEALTH","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,68.239999999999995,11.81,456.36,32.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 80069","AETNA - AETNA STUDENT HEALTH - 80069 - CHG RENAL FUNCTION PANEL","AETNA","AETNA STUDENT HEALTH","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,103.16,7.66,456.36,48.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 80076","AETNA - AETNA STUDENT HEALTH - 80076 - CHG HEPATIC FUNCTION PANEL","AETNA","AETNA STUDENT HEALTH","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,86.23,7.21,456.36,40.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 81000","AETNA - AETNA STUDENT HEALTH - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA STUDENT HEALTH - CPT - 81000","AETNA - AETNA STUDENT HEALTH - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,12.7,2.89,456.36,6]
["AETNA - AETNA STUDENT HEALTH - CPT - 81001","AETNA - AETNA STUDENT HEALTH - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12.7,2.8,456.36,6]
["AETNA - AETNA STUDENT HEALTH - CPT - 81002","AETNA - AETNA STUDENT HEALTH - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 81002","AETNA - AETNA STUDENT HEALTH - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 81003","AETNA - AETNA STUDENT HEALTH - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 81003","AETNA - AETNA STUDENT HEALTH - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","AETNA","AETNA STUDENT HEALTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,8.99,1.63,456.36,4.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 84153","AETNA - AETNA STUDENT HEALTH - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","AETNA","AETNA STUDENT HEALTH","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 84443","AETNA - AETNA STUDENT HEALTH - 84443 - CHG ASSAY THYROID STIM HORMONE","AETNA","AETNA STUDENT HEALTH","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 85025","AETNA - AETNA STUDENT HEALTH - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","AETNA","AETNA STUDENT HEALTH","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,29.1,6.85,456.36,13.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 85027","AETNA - AETNA STUDENT HEALTH - 85027 - CHG COMPLETE CBC","AETNA","AETNA STUDENT HEALTH","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,23.81,5.71,456.36,11.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 85610","AETNA - AETNA STUDENT HEALTH - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA STUDENT HEALTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 85610","AETNA - AETNA STUDENT HEALTH - 85610 - CHG PROTHROMBIN TIME","AETNA","AETNA STUDENT HEALTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,15.34,3.58,456.36,7.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 85730","AETNA - AETNA STUDENT HEALTH - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA STUDENT HEALTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 85730","AETNA - AETNA STUDENT HEALTH - 85730 - CHG THROMBOPLAS TIME PARTIAL","AETNA","AETNA STUDENT HEALTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,22.22,5.3,456.36,10.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 90662","AETNA - AETNA STUDENT HEALTH - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","AETNA","AETNA STUDENT HEALTH","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 90686","AETNA - AETNA STUDENT HEALTH - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","AETNA","AETNA STUDENT HEALTH","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,39.15,19.16,456.36,18.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 90715","AETNA - AETNA STUDENT HEALTH - 90715 - PR TDAP VACCINE >7 YO, IM","AETNA","AETNA STUDENT HEALTH","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,95.22,39.75,456.36,45]
["AETNA - AETNA STUDENT HEALTH - CPT - 90832","AETNA - AETNA STUDENT HEALTH - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,88.87,21.97,456.36,42]
["AETNA - AETNA STUDENT HEALTH - CPT - 90834","AETNA - AETNA STUDENT HEALTH - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 90837","AETNA - AETNA STUDENT HEALTH - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,113.74,27.84,456.36,53.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 90846","AETNA - AETNA STUDENT HEALTH - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","AETNA","AETNA STUDENT HEALTH","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,162.93,30.9,456.36,77]
["AETNA - AETNA STUDENT HEALTH - CPT - 90847","AETNA - AETNA STUDENT HEALTH - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","AETNA","AETNA STUDENT HEALTH","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,192.03,30.9,456.36,90.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 90853","AETNA - AETNA STUDENT HEALTH - 90853 - PR GROUP PSYCHOTHERAPY","AETNA","AETNA STUDENT HEALTH","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,68.239999999999995,15.63,456.36,32.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 93452","AETNA - AETNA STUDENT HEALTH - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","AETNA","AETNA STUDENT HEALTH","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 95810","AETNA - AETNA STUDENT HEALTH - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","AETNA","AETNA STUDENT HEALTH","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2081.62,420.34,3344.75,983.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 97110","AETNA - AETNA STUDENT HEALTH - 97110 - PR THERAPEUTIC EXERCISES","AETNA","AETNA STUDENT HEALTH","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,131.72,23.1,456.36,62.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99203","AETNA - AETNA STUDENT HEALTH - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99203","AETNA - AETNA STUDENT HEALTH - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,219.54,23.27,456.36,103.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99204","AETNA - AETNA STUDENT HEALTH - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99204","AETNA - AETNA STUDENT HEALTH - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,372.95,23.27,705,176.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99205","AETNA - AETNA STUDENT HEALTH - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99205","AETNA - AETNA STUDENT HEALTH - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99212","AETNA - AETNA STUDENT HEALTH - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99212","AETNA - AETNA STUDENT HEALTH - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,77.760000000000005,23.27,456.36,36.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99213","AETNA - AETNA STUDENT HEALTH - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99213","AETNA - AETNA STUDENT HEALTH - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["AETNA - AETNA STUDENT HEALTH - CPT - 99214","AETNA - AETNA STUDENT HEALTH - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 99214","AETNA - AETNA STUDENT HEALTH - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,223.24,23.27,456.36,105.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 99215","AETNA - AETNA STUDENT HEALTH - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99215","AETNA - AETNA STUDENT HEALTH - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","AETNA","AETNA STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["AETNA - AETNA STUDENT HEALTH - CPT - 99385","AETNA - AETNA STUDENT HEALTH - 99385 - PR PREVENTIVE VISIT,NEW,18-39","AETNA","AETNA STUDENT HEALTH","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,280.37,23.27,530,132.5]
["AETNA - AETNA STUDENT HEALTH - CPT - 99386","AETNA - AETNA STUDENT HEALTH - 99386 - PR PREVENTIVE VISIT,NEW,40-64","AETNA","AETNA STUDENT HEALTH","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,338.56,23.27,640,160]
["AETNA - AETNA STUDENT HEALTH - CPT - A9500","AETNA - AETNA STUDENT HEALTH - A9500 - PR TC99M SESTAMIBI","AETNA","AETNA STUDENT HEALTH","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,188.85,128.52000000000001,456.36,89.25]
["AETNA - AETNA STUDENT HEALTH - CPT - A9513","AETNA - AETNA STUDENT HEALTH - A9513 - DELETED 2077","AETNA","AETNA STUDENT HEALTH","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,226.94,154.44,456.36,107.25]
["AETNA - AETNA STUDENT HEALTH - CPT - A9517","AETNA - AETNA STUDENT HEALTH - A9517 - PR I131 IODIDE CAP, RX","AETNA","AETNA STUDENT HEALTH","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,276.67,20.12,456.36,130.75]
["AETNA - AETNA STUDENT HEALTH - CPT - A9552","AETNA - AETNA STUDENT HEALTH - A9552 - PR F18 FDG","AETNA","AETNA STUDENT HEALTH","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,536.94000000000005,365.4,1015,253.75]
["AETNA - AETNA STUDENT HEALTH - CPT - A9555","AETNA - AETNA STUDENT HEALTH - A9555 - PR RB82 RUBIDIUM","AETNA","AETNA STUDENT HEALTH","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,732.67,420.34,1385,346.25]
["AETNA - AETNA STUDENT HEALTH - CPT - A9575","AETNA - AETNA STUDENT HEALTH - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","AETNA","AETNA STUDENT HEALTH","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,4.2300000000000004,0.13,456.36,2]
["AETNA - AETNA STUDENT HEALTH - CPT - A9579","AETNA - AETNA STUDENT HEALTH - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA STUDENT HEALTH","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,2.12,1.08,456.36,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9579","AETNA - AETNA STUDENT HEALTH - A9579 - GAD-BASE MR CONTRAST NOS,1ML","AETNA","AETNA STUDENT HEALTH","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,2.12,1.08,456.36,1]
["AETNA - AETNA STUDENT HEALTH - CPT - A9581","AETNA - AETNA STUDENT HEALTH - A9581 - PR GADOXETATE DISODIUM INJ","AETNA","AETNA STUDENT HEALTH","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,52.37,15.3,456.36,24.75]
["AETNA - AETNA STUDENT HEALTH - CPT - J1030","AETNA - AETNA STUDENT HEALTH - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","AETNA","AETNA STUDENT HEALTH","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["AETNA - AETNA STUDENT HEALTH - CPT - J3301","AETNA - AETNA STUDENT HEALTH - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA STUDENT HEALTH","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9.52,0.98,456.36,4.5]
["AETNA - AETNA STUDENT HEALTH - CPT - P9047","AETNA - AETNA STUDENT HEALTH - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA STUDENT HEALTH","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,95.22,50.13,456.36,45]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9958","AETNA - AETNA STUDENT HEALTH - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,0.53,0.09,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9963","AETNA - AETNA STUDENT HEALTH - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.53,0.22,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9963","AETNA - AETNA STUDENT HEALTH - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.53,0.22,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9966","AETNA - AETNA STUDENT HEALTH - Q9966 - LOCM 200-299MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,0.53,0.36,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA - AETNA STUDENT HEALTH - CPT - Q9967","AETNA - AETNA STUDENT HEALTH - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA STUDENT HEALTH","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.64777777777777779,0.12,456.36,0.30555555555555558]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 19120","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 19120 - PR EXCISE BREAST CYST","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 29881","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 43235","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1017.81,420.34,1871.88,376.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 43239","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1017.81,420.34,1871.88,428]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45378","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45380","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1324.99,420.34,2575,643.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45385","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1324.99,420.34,2929.62,760]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 45391","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1324.99,420.34,2924,731]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 55700","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 55700","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62322","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62322","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 62323","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 64483","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 66821","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 66821 - PR DISCISSION,2ND CATARACT,LASER","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 66984","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70450","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,123.44,113.99,1718.7,505.5]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70553","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70553 - CHG MRI BRAIN COMBO","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 70553","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 70553 - CHG MRI BRAIN COMBO","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72110","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72148","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72148 - CHG MRI, LUMBAR SPINE","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,275.13,254.07,3938.05,1158.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 72193","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 72193 - CHG CT SCAN OF PELVIS CONTRAST","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 73721","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,275.13,254.07,4304.3999999999996,1266]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 74177","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 80048","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - 90834","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - P9047","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - CPT - Q9967","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS HMO - CPT - 72110","BCBS - BCBS HMO - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","BCBS","BCBS HMO","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,128.66,46.45,595,148.75]
["BCBS - BCBS HMO - CPT - 85730","BCBS - BCBS HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","BCBS","BCBS HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,12.03,5.3,456.36,10.5]
["BCBS - BCBS HMO - CPT - 99214","BCBS - BCBS HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","BCBS","BCBS HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,32.18,23.27,456.36,105.5]
["BCBS - BCBS HMO - CPT - Q9967","BCBS - BCBS HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS","BCBS HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS INDEMNITY - CPT - 45378","BCBS - BCBS INDEMNITY - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","BCBS","BCBS INDEMNITY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1370.57,395.43,2154,538.5]
["BCBS - BCBS INDEMNITY - CPT - 80061","BCBS - BCBS INDEMNITY - 80061 - CHG LIPID PANEL","BCBS","BCBS INDEMNITY","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,26.35,11.81,456.36,32.25]
["BCBS - BCBS INDEMNITY - CPT - 99204","BCBS - BCBS INDEMNITY - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","BCBS","BCBS INDEMNITY","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,32.18,23.27,705,176.25]
["BCBS - BCBS INDEMNITY - CPT - A9579","BCBS - BCBS INDEMNITY - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BCBS","BCBS INDEMNITY","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["BCBS - BCBS INDEMNITY - CPT - Q9967","BCBS - BCBS INDEMNITY - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS","BCBS INDEMNITY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS POS - CPT - 76830","BCBS - BCBS POS - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","BCBS","BCBS POS","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,128.66,113.99,873.8,257]
["BCBS - BCBS POS - CPT - 85730","BCBS - BCBS POS - 85730 - CHG THROMBOPLAS TIME PARTIAL","BCBS","BCBS POS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,12.03,5.3,456.36,10.5]
["BCBS - BCBS POS - CPT - A9513","BCBS - BCBS POS - A9513 - DELETED 2077","BCBS","BCBS POS","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,318.61,154.44,456.36,107.25]
["BCBS - BCBS POS - CPT - A9579","BCBS - BCBS POS - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BCBS","BCBS POS","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["BCBS - BCBS PPO - CPT - 62323","BCBS - BCBS PPO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","BCBS","BCBS PPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1101.79,420.34,1505.24,371.25]
["BCBS - BCBS PPO - CPT - 80076","BCBS - BCBS PPO - 80076 - CHG HEPATIC FUNCTION PANEL","BCBS","BCBS PPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,16.04,7.21,456.36,40.75]
["BCBS - BCBS PPO - CPT - 99205","BCBS - BCBS PPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","BCBS","BCBS PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,32.18,23.27,899,224.75]
["BCBS - BCBS PPO - CPT - 99385","BCBS - BCBS PPO - 99385 - PR PREVENTIVE VISIT,NEW,18-39","BCBS","BCBS PPO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,342.38,23.27,530,132.5]
["BCBS - BCBS PPO - CPT - Q9967","BCBS - BCBS PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS","BCBS PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS - BCBS SHIP PPO - CPT - 76830","BCBS - BCBS SHIP PPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","BCBS","BCBS SHIP PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,128.66,113.99,873.8,257]
["BCBS - BCBS SHIP PPO - CPT - 81000","BCBS - BCBS SHIP PPO - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","BCBS","BCBS SHIP PPO","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,6.3,2.89,456.36,6]
["BCBS - BCBS SHIP PPO - CPT - 95810","BCBS - BCBS SHIP PPO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","BCBS","BCBS SHIP PPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1679.52,420.34,3344.75,983.75]
["BCBS - BCBS SHIP PPO - CPT - Q9966","BCBS - BCBS SHIP PPO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","BCBS","BCBS SHIP PPO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["BCBS - BCBS STANDARD - CPT - 73721","BCBS - BCBS STANDARD - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","BCBS","BCBS STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,574.25,254.07,4304.3999999999996,1266]
["BCBS - BCBS STANDARD - CPT - 84443","BCBS - BCBS STANDARD - 84443 - CHG ASSAY THYROID STIM HORMONE","BCBS","BCBS STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,33.22,14.82,456.36,28.5]
["BCBS - BCBS STANDARD - CPT - 90715","BCBS - BCBS STANDARD - 90715 - PR TDAP VACCINE >7 YO, IM","BCBS","BCBS STANDARD","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["BCBS - BCBS STANDARD - CPT - 99386","BCBS - BCBS STANDARD - 99386 - PR PREVENTIVE VISIT,NEW,40-64","BCBS","BCBS STANDARD","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,413.44,23.27,640,160]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 62323","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1101.79,420.34,1505.24,371.25]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 66984","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,3527.53,420.34,4241.13,556]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 81000","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,6.3,2.89,456.36,6]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - 99212","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,32.18,23.27,456.36,36.75]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - CPT - A9581","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - A9581 - PR GADOXETATE DISODIUM INJ","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 74177","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 77067","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - 99203","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - P9047","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - CPT - Q9967","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 70553","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - 70553 - CHG MRI BRAIN COMBO","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 90853","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - 90853 - PR GROUP PSYCHOTHERAPY","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,100.08,15.63,456.36,32.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - CPT - 99214","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 45378","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1370.57,395.43,2154,538.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 62323","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1101.79,420.34,1505.24,371.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 90662","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,73.400000000000006,36.119999999999997,456.36,32.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 99205","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,32.18,23.27,899,224.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - 99385","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - 99385 - PR PREVENTIVE VISIT,NEW,18-39","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,342.38,23.27,530,132.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - CPT - Q9967","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 74177","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,961.1,398.75,2773.55,815.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - 90686","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,22.35,19.16,456.36,18.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - A9579","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - A9579 - GAD-BASE MR CONTRAST NOS,1ML","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - CPT - Q9966","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - Q9966 - LOCM 200-299MG/ML IODINE,1ML","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 64483","BCBS OUT OF STATE - BCBS OUT OF STATE POS - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1407.29,420.34,1879.97,386.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 84443","BCBS OUT OF STATE - BCBS OUT OF STATE POS - 84443 - CHG ASSAY THYROID STIM HORMONE","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,33.22,14.82,456.36,28.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - 99212","BCBS OUT OF STATE - BCBS OUT OF STATE POS - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,32.18,23.27,456.36,36.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - CPT - Q9967","BCBS OUT OF STATE - BCBS OUT OF STATE POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS OUT OF STATE","BCBS OUT OF STATE POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 45385","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1802.8,420.34,2929.62,760]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 77066","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,214.37,131.5,924,231]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 95810","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1679.52,420.34,3344.75,983.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - 99205","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,32.18,23.27,899,224.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - CPT - Q9967","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA - CCA SCO ONECARE - CPT - 74177","CCA - CCA SCO ONECARE - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","CCA","CCA SCO ONECARE","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,453.39,398.75,2773.55,815.75]
["CCA - CCA SCO ONECARE - CPT - 85025","CCA - CCA SCO ONECARE - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","CCA","CCA SCO ONECARE","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,8.16,6.85,456.36,13.75]
["CCA - CCA SCO ONECARE - CPT - 93452","CCA - CCA SCO ONECARE - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","CCA","CCA SCO ONECARE","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["CCA - CCA SCO ONECARE - CPT - Q9963","CCA - CCA SCO ONECARE - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","CCA","CCA SCO ONECARE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["CCA - CCA SCO STANDARD - CPT - 62322","CCA - CCA SCO STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CCA","CCA SCO STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["CCA - CCA SCO STANDARD - CPT - 81003","CCA - CCA SCO STANDARD - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","CCA","CCA SCO STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25]
["CCA - CCA SCO STANDARD - CPT - 90847","CCA - CCA SCO STANDARD - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","CCA","CCA SCO STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,187.97,30.9,456.36,90.75]
["CCA - CCA SCO STANDARD - CPT - A9513","CCA - CCA SCO STANDARD - A9513 - DELETED 2077","CCA","CCA SCO STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,304.95999999999998,154.44,456.36,107.25]
["CCA - ZZZCCA STANDARD - CPT - 45391","CCA - ZZZCCA STANDARD - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","CCA","ZZZCCA STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1391.24,420.34,2924,731]
["CCA - ZZZCCA STANDARD - CPT - 81000","CCA - ZZZCCA STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","CCA","ZZZCCA STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6]
["CCA - ZZZCCA STANDARD - CPT - 81002","CCA - ZZZCCA STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","CCA","ZZZCCA STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25]
["CCA - ZZZCCA STANDARD - CPT - 99214","CCA - ZZZCCA STANDARD - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","CCA","ZZZCCA STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,155.85,23.27,456.36,105.5]
["CCA - ZZZCCA STANDARD - CPT - Q9967","CCA - ZZZCCA STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CCA","ZZZCCA STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 62323","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,815.3,420.34,1505.24,371.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 90715","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - 90715 - PR TDAP VACCINE >7 YO, IM","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - 97110","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - 97110 - PR THERAPEUTIC EXERCISES","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,33.72,23.1,456.36,62.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - CPT - Q9967","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 45385","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1391.24,420.34,2929.62,760]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 76805","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,129.61000000000001,113.99,1013.2,298]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - 90847","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,187.97,30.9,456.36,90.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - CPT - A9579","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 45378","CCA MEDICARE PREFERRED - ZZZCCA - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CCA MEDICARE PREFERRED","ZZZCCA","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 80076","CCA MEDICARE PREFERRED - ZZZCCA - 80076 - CHG HEPATIC FUNCTION PANEL","CCA MEDICARE PREFERRED","ZZZCCA","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.58,7.21,456.36,40.75]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - 84443","CCA MEDICARE PREFERRED - ZZZCCA - 84443 - CHG ASSAY THYROID STIM HORMONE","CCA MEDICARE PREFERRED","ZZZCCA","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,17.64,14.82,456.36,28.5]
["CCA MEDICARE PREFERRED - ZZZCCA - CPT - A9517","CCA MEDICARE PREFERRED - ZZZCCA - A9517 - PR I131 IODIDE CAP, RX","CCA MEDICARE PREFERRED","ZZZCCA","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.41,20.12,456.36,130.75]
["CIGNA - CIGNA CARELINK - CPT - 19120","CIGNA - CIGNA CARELINK - 19120 - PR EXCISE BREAST CYST","CIGNA","CIGNA CARELINK","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,5615.19,420.34,6229.57,1049.75]
["CIGNA - CIGNA CARELINK - CPT - 62322","CIGNA - CIGNA CARELINK - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CIGNA","CIGNA CARELINK","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5]
["CIGNA - CIGNA CARELINK - CPT - 81002","CIGNA - CIGNA CARELINK - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","CIGNA","CIGNA CARELINK","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,9.51,2.34,456.36,4.25]
["CIGNA - CIGNA CARELINK - CPT - 90853","CIGNA - CIGNA CARELINK - 90853 - PR GROUP PSYCHOTHERAPY","CIGNA","CIGNA CARELINK","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,18.329999999999998,15.63,456.36,32.25]
["CIGNA - CIGNA CARELINK - CPT - Q9967","CIGNA - CIGNA CARELINK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CIGNA","CIGNA CARELINK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CIGNA - CIGNA LOCALPLUS - CPT - 70553","CIGNA - CIGNA LOCALPLUS - 70553 - CHG MRI BRAIN COMBO","CIGNA","CIGNA LOCALPLUS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,5879.45,398.75,5879.45,1729.25]
["CIGNA - CIGNA LOCALPLUS - CPT - 76805","CIGNA - CIGNA LOCALPLUS - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","CIGNA","CIGNA LOCALPLUS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,1013.2,113.99,1013.2,298]
["CIGNA - CIGNA LOCALPLUS - CPT - 90715","CIGNA - CIGNA LOCALPLUS - 90715 - PR TDAP VACCINE >7 YO, IM","CIGNA","CIGNA LOCALPLUS","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,153,39.75,456.36,45]
["CIGNA - CIGNA LOCALPLUS - CPT - A9555","CIGNA - CIGNA LOCALPLUS - A9555 - PR RB82 RUBIDIUM","CIGNA","CIGNA LOCALPLUS","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1177.25,420.34,1385,346.25]
["CIGNA - CIGNA LOCALPLUS - CPT - Q9963","CIGNA - CIGNA LOCALPLUS - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","CIGNA","CIGNA LOCALPLUS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.85,0.22,456.36,0.25]
["CIGNA - CIGNA STANDARD - CPT - 62322","CIGNA - CIGNA STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CIGNA","CIGNA STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1212.0999999999999,82.95,1426,356.5]
["CIGNA - CIGNA STANDARD - CPT - 84153","CIGNA - CIGNA STANDARD - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","CIGNA","CIGNA STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,20.34,13.26,456.36,31.25]
["CIGNA - CIGNA STANDARD - CPT - 99215","CIGNA - CIGNA STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","CIGNA","CIGNA STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,505.75,23.27,595,148.75]
["CIGNA - CIGNA STANDARD - CPT - Q9967","CIGNA - CIGNA STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CIGNA","CIGNA STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.0388888888888888,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 45378","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 81000","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 95810","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - 99212","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,96.429999999999993,23.27,456.36,36.75]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - CPT - Q9967","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 80053","CORRECTIONS - CORRECTIONS BRISTOL - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","CORRECTIONS","CORRECTIONS BRISTOL","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,11.09,9.31,456.36,67.75]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - 90846","CORRECTIONS - CORRECTIONS BRISTOL - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","CORRECTIONS","CORRECTIONS BRISTOL","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,187.97,30.9,456.36,77]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - A9575","CORRECTIONS - CORRECTIONS BRISTOL - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","CORRECTIONS","CORRECTIONS BRISTOL","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["CORRECTIONS - CORRECTIONS BRISTOL - CPT - Q9967","CORRECTIONS - CORRECTIONS BRISTOL - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS BRISTOL","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 64483","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1074.5899999999999,420.34,1879.97,386.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 84153","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - 90832","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,187.97,21.97,456.36,42]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - CPT - Q9963","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 55700","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 81002","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - 99204","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,147.94,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - Q9958","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - CPT - Q9967","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 77065","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - 81000","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - A9579","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - CPT - Q9967","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 76805","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 81002","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - 93452","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - CPT - A9581","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - A9581 - PR GADOXETATE DISODIUM INJ","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 66821","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - 66821 - PR DISCISSION,2ND CATARACT,LASER","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,685.29,420.34,2389.35,702.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 81001","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.33,2.8,456.36,6]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - 85027","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - 85027 - CHG COMPLETE CBC","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.79,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - CPT - A9555","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - A9555 - PR RB82 RUBIDIUM","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 45378","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1128.82,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 80055","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - 80055 - CHG OBSTETRIC PANEL","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,52.59,18.32,456.36,65]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 81003","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.48,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - CPT - 99212","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,100.14,23.27,456.36,36.75]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 19120","CORRECTIONS - CORRECTIONS ICE INMATE - 19120 - PR EXCISE BREAST CYST","CORRECTIONS","CORRECTIONS ICE INMATE","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 55700","CORRECTIONS - CORRECTIONS ICE INMATE - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","CORRECTIONS","CORRECTIONS ICE INMATE","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 80048","CORRECTIONS - CORRECTIONS ICE INMATE - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","CORRECTIONS","CORRECTIONS ICE INMATE","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - 99204","CORRECTIONS - CORRECTIONS ICE INMATE - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","CORRECTIONS","CORRECTIONS ICE INMATE","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,147.94,23.27,705,176.25]
["CORRECTIONS - CORRECTIONS ICE INMATE - CPT - Q9963","CORRECTIONS - CORRECTIONS ICE INMATE - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS ICE INMATE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 45378","CORRECTIONS - CORRECTIONS MIDDLESEX - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","CORRECTIONS MIDDLESEX","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 76830","CORRECTIONS - CORRECTIONS MIDDLESEX - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","CORRECTIONS","CORRECTIONS MIDDLESEX","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - 90715","CORRECTIONS - CORRECTIONS MIDDLESEX - 90715 - PR TDAP VACCINE >7 YO, IM","CORRECTIONS","CORRECTIONS MIDDLESEX","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["CORRECTIONS - CORRECTIONS MIDDLESEX - CPT - Q9963","CORRECTIONS - CORRECTIONS MIDDLESEX - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS MIDDLESEX","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 55700","CORRECTIONS - CORRECTIONS NAPHCARE - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","CORRECTIONS","CORRECTIONS NAPHCARE","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 70553","CORRECTIONS - CORRECTIONS NAPHCARE - 70553 - CHG MRI BRAIN COMBO","CORRECTIONS","CORRECTIONS NAPHCARE","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,453.39,398.75,5879.45,1729.25]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - 85610","CORRECTIONS - CORRECTIONS NAPHCARE - 85610 - CHG PROTHROMBIN TIME","CORRECTIONS","CORRECTIONS NAPHCARE","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.5,3.58,456.36,7.25]
["CORRECTIONS - CORRECTIONS NAPHCARE - CPT - A9579","CORRECTIONS - CORRECTIONS NAPHCARE - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CORRECTIONS","CORRECTIONS NAPHCARE","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 45378","CORRECTIONS - CORRECTIONS NASHUA - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","CORRECTIONS NASHUA","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 64483","CORRECTIONS - CORRECTIONS NASHUA - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","CORRECTIONS","CORRECTIONS NASHUA","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1074.5899999999999,420.34,1879.97,386.25]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 80076","CORRECTIONS - CORRECTIONS NASHUA - 80076 - CHG HEPATIC FUNCTION PANEL","CORRECTIONS","CORRECTIONS NASHUA","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.58,7.21,456.36,40.75]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - 90846","CORRECTIONS - CORRECTIONS NASHUA - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","CORRECTIONS","CORRECTIONS NASHUA","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,187.97,30.9,456.36,77]
["CORRECTIONS - CORRECTIONS NASHUA - CPT - Q9967","CORRECTIONS - CORRECTIONS NASHUA - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS NASHUA","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 43239","CORRECTIONS - CORRECTIONS NORFOLK - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","CORRECTIONS","CORRECTIONS NORFOLK","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1068.7,420.34,1871.88,428]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 80053","CORRECTIONS - CORRECTIONS NORFOLK - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","CORRECTIONS","CORRECTIONS NORFOLK","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,11.09,9.31,456.36,67.75]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - 85730","CORRECTIONS - CORRECTIONS NORFOLK - 85730 - CHG THROMBOPLAS TIME PARTIAL","CORRECTIONS","CORRECTIONS NORFOLK","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - Q9966","CORRECTIONS - CORRECTIONS NORFOLK - Q9966 - LOCM 200-299MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS NORFOLK","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["CORRECTIONS - CORRECTIONS NORFOLK - CPT - Q9967","CORRECTIONS - CORRECTIONS NORFOLK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS NORFOLK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 62322","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 76700","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,129.61000000000001,111.92,961.35,282.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81000","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 81003","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 90834","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,187.97,27.84,456.36,53.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - 99213","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,112.53999999999999,23.27,456.36,69.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - Q9958","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - CPT - Q9967","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 45378","CORRECTIONS - CORRECTIONS PLYMOUTH - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 81000","CORRECTIONS - CORRECTIONS PLYMOUTH - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 99203","CORRECTIONS - CORRECTIONS PLYMOUTH - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,120.89,23.27,456.36,103.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH - CPT - 99214","CORRECTIONS - CORRECTIONS PLYMOUTH - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","CORRECTIONS","CORRECTIONS PLYMOUTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,128.995,23.27,456.36,105.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 29881","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 64483","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1074.5899999999999,420.34,1879.97,386.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 76830","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 81002","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 85027","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 85027 - CHG COMPLETE CBC","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,6.79,5.71,456.36,11.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 97110","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 97110 - PR THERAPEUTIC EXERCISES","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,33.72,23.1,456.36,62.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - 99215","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,153.80000000000001,23.27,595,148.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - A9517","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - A9517 - PR I131 IODIDE CAP, RX","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.41,20.12,456.36,130.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - CPT - Q9967","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 62323","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,854.12,420.34,1505.24,371.25]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 81003","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.48,1.63,456.36,4.25]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - 85730","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - 85730 - CHG THROMBOPLAS TIME PARTIAL","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.61,5.3,456.36,10.5]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - CPT - A9517","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - A9517 - PR I131 IODIDE CAP, RX","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,23.47,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 55700","CORRECTIONS - ZZZCORRECTIONS BAY STATE - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2401.3000000000002,420.34,3848.68,587]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 80048","CORRECTIONS - ZZZCORRECTIONS BAY STATE - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.8800000000000008,7.46,456.36,41.75]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 85610","CORRECTIONS - ZZZCORRECTIONS BAY STATE - 85610 - CHG PROTHROMBIN TIME","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.5,3.58,456.36,7.25]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - 99205","CORRECTIONS - ZZZCORRECTIONS BAY STATE - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,173.23000000000002,23.27,899,224.75]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS BAY STATE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS BAY STATE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 76830","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 81003","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - 99203","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,120.89,23.27,456.36,103.75]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 70553","CORRECTIONS - ZZZCORRECTIONS BRADSTON - 70553 - CHG MRI BRAIN COMBO","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,453.39,398.75,5879.45,1729.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 81002","CORRECTIONS - ZZZCORRECTIONS BRADSTON - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - 85730","CORRECTIONS - ZZZCORRECTIONS BRADSTON - 85730 - CHG THROMBOPLAS TIME PARTIAL","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - CPT - A9579","CORRECTIONS - ZZZCORRECTIONS BRADSTON - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CORRECTIONS","ZZZCORRECTIONS BRADSTON","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 45378","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 81000","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 85025","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,8.16,6.85,456.36,13.75]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - 99213","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,112.53999999999999,23.27,456.36,69.25]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 62322","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 80061","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - 80061 - CHG LIPID PANEL","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,14.06,11.81,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - 99205","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,173.23000000000002,23.27,899,224.75]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 74177","CORRECTIONS - ZZZCORRECTIONS CEDAR - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,453.39,398.75,2773.55,815.75]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 77067","CORRECTIONS - ZZZCORRECTIONS CEDAR - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - 90837","CORRECTIONS - ZZZCORRECTIONS CEDAR - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,187.97,27.84,456.36,53.75]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - Q9966","CORRECTIONS - ZZZCORRECTIONS CEDAR - Q9966 - LOCM 200-299MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS CEDAR - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS CEDAR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 72148","CORRECTIONS - ZZZCORRECTIONS CONCORD - 72148 - CHG MRI, LUMBAR SPINE","CORRECTIONS","ZZZCORRECTIONS CONCORD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,288.89,254.07,3938.05,1158.25]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 85730","CORRECTIONS - ZZZCORRECTIONS CONCORD - 85730 - CHG THROMBOPLAS TIME PARTIAL","CORRECTIONS","ZZZCORRECTIONS CONCORD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - CPT - 99204","CORRECTIONS - ZZZCORRECTIONS CONCORD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","CORRECTIONS","ZZZCORRECTIONS CONCORD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,147.94,23.27,705,176.25]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 45391","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1391.24,420.34,2924,731]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 70450","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,129.61000000000001,113.99,1718.7,505.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 84153","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - 99214","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,128.995,23.27,456.36,105.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - CPT - A9579","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 45378","CORRECTIONS - ZZZCORRECTIONS GARDNER - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 81003","CORRECTIONS - ZZZCORRECTIONS GARDNER - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - 97110","CORRECTIONS - ZZZCORRECTIONS GARDNER - 97110 - PR THERAPEUTIC EXERCISES","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,33.72,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS GARDNER - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS GARDNER","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 43235","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1068.7,420.34,1871.88,376.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 80076","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - 80076 - CHG HEPATIC FUNCTION PANEL","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.58,7.21,456.36,40.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 90847","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,187.97,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - 99205","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,173.23000000000002,23.27,899,224.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - CPT - Q9966","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - Q9966 - LOCM 200-299MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 62322","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - 84443","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - 84443 - CHG ASSAY THYROID STIM HORMONE","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,17.64,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - A9517","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - A9517 - PR I131 IODIDE CAP, RX","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.41,20.12,456.36,130.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - CPT - P9047","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,55.73,50.13,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 45380","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1391.24,420.34,2575,643.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 81002","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - 85730","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - 85730 - CHG THROMBOPLAS TIME PARTIAL","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 45385","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 77066","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,131.5,131.5,924,231]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 99203","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,120.89,23.27,456.36,103.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - 99204","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,147.94,23.27,705,176.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 76805","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 85730","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - 85730 - CHG THROMBOPLAS TIME PARTIAL","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - 93452","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 66984","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2747.38,420.34,4241.13,556]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 85025","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,8.16,6.85,456.36,13.75]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - 90847","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,187.97,30.9,456.36,90.75]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - CPT - A9575","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 62322","CORRECTIONS - ZZZCORRECTIONS NASHUA - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CORRECTIONS","ZZZCORRECTIONS NASHUA","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 81000","CORRECTIONS - ZZZCORRECTIONS NASHUA - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","CORRECTIONS","ZZZCORRECTIONS NASHUA","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.22,2.89,456.36,6]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - 84153","CORRECTIONS - ZZZCORRECTIONS NASHUA - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","CORRECTIONS","ZZZCORRECTIONS NASHUA","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - CPT - A9513","CORRECTIONS - ZZZCORRECTIONS NASHUA - A9513 - DELETED 2077","CORRECTIONS","ZZZCORRECTIONS NASHUA","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,304.95999999999998,154.44,456.36,107.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 29881","CORRECTIONS - ZZZCORRECTIONS NORFOLK - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 62323","CORRECTIONS - ZZZCORRECTIONS NORFOLK - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,815.3,420.34,1505.24,371.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 90846","CORRECTIONS - ZZZCORRECTIONS NORFOLK - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,187.97,30.9,456.36,77]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - 99204","CORRECTIONS - ZZZCORRECTIONS NORFOLK - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,147.94,23.27,705,176.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS NORFOLK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS NORFOLK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 45385","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1391.24,420.34,2929.62,760]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 77065","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - 97110","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - 97110 - PR THERAPEUTIC EXERCISES","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,33.72,23.1,456.36,62.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - CPT - J3301","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 45378","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1077.51,395.43,2154,538.5]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 81002","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.65,2.34,456.36,4.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - 85610","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - 85610 - CHG PROTHROMBIN TIME","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.5,3.58,456.36,7.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - CPT - A9579","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - A9579 - GAD-BASE MR CONTRAST NOS,1ML","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 19120","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - 19120 - PR EXCISE BREAST CYST","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 66821","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - 66821 - PR DISCISSION,2ND CATARACT,LASER","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,685.29,420.34,2389.35,702.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 84443","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - 84443 - CHG ASSAY THYROID STIM HORMONE","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,17.64,14.82,456.36,28.5]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - CPT - 95810","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 43239","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1068.7,420.34,1871.88,428]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 76805","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,129.61000000000001,113.99,1013.2,298]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 80055","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - 80055 - CHG OBSTETRIC PANEL","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,50.2,18.32,456.36,65]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - 90853","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - 90853 - PR GROUP PSYCHOTHERAPY","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,105.09,15.63,456.36,32.25]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 19120","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - 19120 - PR EXCISE BREAST CYST","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4493.84,420.34,6229.57,1049.75]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 74177","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,453.39,398.75,2773.55,815.75]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - 90715","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - 90715 - PR TDAP VACCINE >7 YO, IM","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - CPT - Q9958","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 62322","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 72110","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,129.61000000000001,46.45,595,148.75]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - 85730","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - 85730 - CHG THROMBOPLAS TIME PARTIAL","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.31,5.3,456.36,10.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - A9500","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - A9500 - PR TC99M SESTAMIBI","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - CPT - J1030","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 45391","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1391.24,420.34,2924,731]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 84153","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,19.309999999999999,13.26,456.36,31.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - 99214","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,128.995,23.27,456.36,105.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - CPT - Q9967","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 45380","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1391.24,420.34,2575,643.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 76830","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,129.61000000000001,113.99,873.8,257]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 95810","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1232.6400000000001,420.34,3344.75,983.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - CPT - 99212","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,96.429999999999993,23.27,456.36,36.75]
["FALLON - FALLON COMMUNITY PLAN - CPT - 29881","FALLON - FALLON COMMUNITY PLAN - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","FALLON","FALLON COMMUNITY PLAN","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2727,420.34,5454,1363.5]
["FALLON - FALLON COMMUNITY PLAN - CPT - 76700","FALLON - FALLON COMMUNITY PLAN - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","FALLON","FALLON COMMUNITY PLAN","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,565.5,111.92,961.35,282.75]
["FALLON - FALLON COMMUNITY PLAN - CPT - 90834","FALLON - FALLON COMMUNITY PLAN - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","FALLON","FALLON COMMUNITY PLAN","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,107.5,27.84,456.36,53.75]
["FALLON - FALLON COMMUNITY PLAN - CPT - A9513","FALLON - FALLON COMMUNITY PLAN - A9513 - DELETED 2077","FALLON","FALLON COMMUNITY PLAN","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,214.5,154.44,456.36,107.25]
["FALLON - FALLON COMMUNITY PLAN - CPT - Q9967","FALLON - FALLON COMMUNITY PLAN - Q9967 - LOCM 300-399MG/ML IODINE,1ML","FALLON","FALLON COMMUNITY PLAN","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.61111111111111116,0.12,456.36,0.30555555555555558]
["FALLON - FALLON HMO STANDARD - CPT - 55700","FALLON - FALLON HMO STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","FALLON","FALLON HMO STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1174,420.34,3848.68,587]
["FALLON - FALLON HMO STANDARD - CPT - 81002","FALLON - FALLON HMO STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","FALLON","FALLON HMO STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.5,2.34,456.36,4.25]
["FALLON - FALLON HMO STANDARD - CPT - 85610","FALLON - FALLON HMO STANDARD - 85610 - CHG PROTHROMBIN TIME","FALLON","FALLON HMO STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,14.5,3.58,456.36,7.25]
["FALLON - FALLON HMO STANDARD - CPT - J3301","FALLON - FALLON HMO STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","FALLON","FALLON HMO STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,9,0.98,456.36,4.5]
["FALLON - FALLON POS STANDARD - CPT - 43239","FALLON - FALLON POS STANDARD - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","FALLON","FALLON POS STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,856,420.34,1871.88,428]
["FALLON - FALLON POS STANDARD - CPT - 80053","FALLON - FALLON POS STANDARD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","FALLON","FALLON POS STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,135.5,9.31,456.36,67.75]
["FALLON - FALLON POS STANDARD - CPT - 90837","FALLON - FALLON POS STANDARD - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","FALLON","FALLON POS STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,107.5,27.84,456.36,53.75]
["FALLON - FALLON POS STANDARD - CPT - 90847","FALLON - FALLON POS STANDARD - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","FALLON","FALLON POS STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,181.5,30.9,456.36,90.75]
["FALLON - FALLON POS STANDARD - CPT - Q9958","FALLON - FALLON POS STANDARD - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","FALLON","FALLON POS STANDARD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,0.5,0.09,456.36,0.25]
["FALLON - FALLON PPO STANDARD - CPT - 70553","FALLON - FALLON PPO STANDARD - 70553 - CHG MRI BRAIN COMBO","FALLON","FALLON PPO STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,3458.5,398.75,5879.45,1729.25]
["FALLON - FALLON PPO STANDARD - CPT - 81001","FALLON - FALLON PPO STANDARD - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","FALLON","FALLON PPO STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,12,2.8,456.36,6]
["FALLON - FALLON PPO STANDARD - CPT - 85730","FALLON - FALLON PPO STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","FALLON","FALLON PPO STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,21,5.3,456.36,10.5]
["FALLON - FALLON PPO STANDARD - CPT - A9555","FALLON - FALLON PPO STANDARD - A9555 - PR RB82 RUBIDIUM","FALLON","FALLON PPO STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,692.5,420.34,1385,346.25]
["FALLON HEALTHCRE ACO - FALLON HEALTHCARE ACO ATRIUS - CPT - 80069","FALLON HEALTHCRE ACO - FALLON HEALTHCARE ACO ATRIUS - 80069 - CHG RENAL FUNCTION PANEL","FALLON HEALTHCRE ACO","FALLON HEALTHCARE ACO ATRIUS","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO BRKSHRE - CPT - 81003","FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO BRKSHRE - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","FALLON HEALTHCRE ACO","FALLON HEALTHCRE ACO BRKSHRE","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO RELIANT - CPT - 80076","FALLON HEALTHCRE ACO - FALLON HEALTHCRE ACO RELIANT - 80076 - CHG HEPATIC FUNCTION PANEL","FALLON HEALTHCRE ACO","FALLON HEALTHCRE ACO RELIANT","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 CARE PLUS - CPT - 81002","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 CARE PLUS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 CARE PLUS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST - CPT - 80048","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST - CPT - 81000","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 STANDARD - CPT - 84443","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO 365 STANDARD - 84443 - CHG ASSAY THYROID STIM HORMONE","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - CPT - 80076","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH - 80076 - CHG HEPATIC FUNCTION PANEL","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST - CPT - 81002","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD - CPT - 80048","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WELLFORCE - CPT - 81002","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WELLFORCE - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WELLFORCE","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE CAREPLUS - CPT - 84443","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE CAREPLUS - 84443 - CHG ASSAY THYROID STIM HORMONE","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE CAREPLUS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 80076","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - 80076 - CHG HEPATIC FUNCTION PANEL","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - CPT - 85025","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75]
["FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE STANDARD - CPT - 85730","FALLON HEALTHCRE ACO - ZZZFALLON HEALTHCRE ACO WLFORCE STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["FALLON MEDICAID MANAGED - FALLON MCD MNG STANDARD - CPT - 81002","FALLON MEDICAID MANAGED - FALLON MCD MNG STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","FALLON MEDICAID MANAGED","FALLON MCD MNG STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 70553","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - 70553 - CHG MRI BRAIN COMBO","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 84153","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - 90686","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,20.72,19.16,456.36,18.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - A9500","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - A9500 - PR TC99M SESTAMIBI","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - CPT - Q9967","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 77067","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 81001","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - 99213","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,148.41999999999999,23.27,456.36,69.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - CPT - A9581","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - A9581 - PR GADOXETATE DISODIUM INJ","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 76805","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 80055","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - 80055 - CHG OBSTETRIC PANEL","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - 90846","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - CPT - A9555","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - A9555 - PR RB82 RUBIDIUM","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["FALLON SCO - FALLON SCO HMO - CPT - 62323","FALLON SCO - FALLON SCO HMO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","FALLON SCO","FALLON SCO HMO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,776.47,420.34,1505.24,371.25]
["FALLON SCO - FALLON SCO HMO - CPT - 72193","FALLON SCO - FALLON SCO HMO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","FALLON SCO","FALLON SCO HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,206.3,190.5,2584,760]
["FALLON SCO - FALLON SCO HMO - CPT - 81001","FALLON SCO - FALLON SCO HMO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","FALLON SCO","FALLON SCO HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.17,2.8,456.36,6]
["FALLON SCO - FALLON SCO HMO - CPT - A9500","FALLON SCO - FALLON SCO HMO - A9500 - PR TC99M SESTAMIBI","FALLON SCO","FALLON SCO HMO","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 45385","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 45391","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,2408.3200000000002,420.34,2924,731]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 80048","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,25.66,7.46,456.36,41.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - 99213","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - CPT - Q9967","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 29881","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,5454,420.34,5454,1363.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 76805","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - 90834","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,108.15,27.84,456.36,53.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - J1030","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - CPT - J3301","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 70553","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - 70553 - CHG MRI BRAIN COMBO","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,755.93,398.75,5879.45,1729.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 85610","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - 85610 - CHG PROTHROMBIN TIME","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - 99213","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - CPT - A9517","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - A9517 - PR I131 IODIDE CAP, RX","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,36.409999999999997,20.12,456.36,130.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 62322","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 80053","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,32.049999999999997,9.31,456.36,67.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 99203","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,415,23.27,456.36,103.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - 99205","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - CPT - Q9967","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 76805","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 85610","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - 85610 - CHG PROTHROMBIN TIME","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - 97110","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - 97110 - PR THERAPEUTIC EXERCISES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,145.28,23.1,456.36,62.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - CPT - A9555","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - A9555 - PR RB82 RUBIDIUM","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 62322","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 81002","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.5500000000000007,2.34,456.36,4.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 90686","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,22.35,19.16,456.36,18.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - CPT - 99215","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 45378","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 76805","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 85027","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - 85027 - CHG COMPLETE CBC","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,17.649999999999999,5.71,456.36,11.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - 90853","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - 90853 - PR GROUP PSYCHOTHERAPY","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,64.89,15.63,456.36,32.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - CPT - Q9963","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 45378","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1830.93,395.43,2154,538.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 72193","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - 72193 - CHG CT SCAN OF PELVIS CONTRAST","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,395.2,190.5,2584,760]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 90662","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,73.400000000000006,36.119999999999997,456.36,32.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - 99215","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - CPT - Q9967","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 64483","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1879.97,420.34,1879.97,386.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 80076","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - 80076 - CHG HEPATIC FUNCTION PANEL","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,22.32,7.21,456.36,40.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - 99205","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - Q9966","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - Q9966 - LOCM 200-299MG/ML IODINE,1ML","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - CPT - Q9967","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 77065","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,752,102.59,752,188]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - 90686","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,22.35,19.16,456.36,18.5]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - A9575","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - CPT - Q9967","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["HLTH NEW ENGLAND ACO - HLTH NEW ENGLAND ACO BE HEALTHY - CPT - 85027","HLTH NEW ENGLAND ACO - HLTH NEW ENGLAND ACO BE HEALTHY - 85027 - CHG COMPLETE CBC","HLTH NEW ENGLAND ACO","HLTH NEW ENGLAND ACO BE HEALTHY","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,5.71,5.71,456.36,11.25]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 76805","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 90846","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,179.02,30.9,456.36,77]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - 90847","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - CPT - Q9963","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["HSN - HSN STANDARD - CPT - 64483","HSN - HSN STANDARD - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","HSN","HSN STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,456.36,420.34,1879.97,386.25]
["HSN - HSN STANDARD - CPT - 84153","HSN - HSN STANDARD - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","HSN","HSN STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,456.36,13.26,456.36,31.25]
["HSN - HSN STANDARD - CPT - 90686","HSN - HSN STANDARD - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","HSN","HSN STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,456.36,19.16,456.36,18.5]
["HSN - HSN STANDARD - CPT - 99385","HSN - HSN STANDARD - 99385 - PR PREVENTIVE VISIT,NEW,18-39","HSN","HSN STANDARD","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,456.36,23.27,530,132.5]
["HSN - HSN TEMPORARY - CPT - 45391","HSN - HSN TEMPORARY - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","HSN","HSN TEMPORARY","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,456.36,420.34,2924,731]
["HSN - HSN TEMPORARY - CPT - 77065","HSN - HSN TEMPORARY - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","HSN","HSN TEMPORARY","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,456.36,102.59,752,188]
["HSN - HSN TEMPORARY - CPT - 81000","HSN - HSN TEMPORARY - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","HSN","HSN TEMPORARY","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,456.36,2.89,456.36,6]
["HSN - HSN TEMPORARY - CPT - 99212","HSN - HSN TEMPORARY - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","HSN","HSN TEMPORARY","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,456.36,23.27,456.36,36.75]
["HSN - HSN TEMPORARY - CPT - Q9967","HSN - HSN TEMPORARY - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HSN","HSN TEMPORARY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 73721","HSN BAD DEBT - HSN BAD DEBT - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","HSN BAD DEBT","HSN BAD DEBT","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,456.36,254.07,4304.3999999999996,1266]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 77066","HSN BAD DEBT - HSN BAD DEBT - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","HSN BAD DEBT","HSN BAD DEBT","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,456.36,131.5,924,231]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 90715","HSN BAD DEBT - HSN BAD DEBT - 90715 - PR TDAP VACCINE >7 YO, IM","HSN BAD DEBT","HSN BAD DEBT","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,456.36,39.75,456.36,45]
["HSN BAD DEBT - HSN BAD DEBT - CPT - 99213","HSN BAD DEBT - HSN BAD DEBT - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","HSN BAD DEBT","HSN BAD DEBT","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,456.36,23.27,456.36,69.25]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 45385","HSN CONFIDENTIAL - HSN CONFIDENTIAL - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,456.36,420.34,2929.62,760]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 66984","HSN CONFIDENTIAL - HSN CONFIDENTIAL - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,456.36,420.34,4241.13,556]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 85025","HSN CONFIDENTIAL - HSN CONFIDENTIAL - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,456.36,6.85,456.36,13.75]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - CPT - 97110","HSN CONFIDENTIAL - HSN CONFIDENTIAL - 97110 - PR THERAPEUTIC EXERCISES","HSN CONFIDENTIAL","HSN CONFIDENTIAL","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,456.36,23.1,456.36,62.25]
["HSN DENTAL - HSN DENTAL - CPT - 19120","HSN DENTAL - HSN DENTAL - 19120 - PR EXCISE BREAST CYST","HSN DENTAL","HSN DENTAL","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,456.36,420.34,6229.57,1049.75]
["HSN DENTAL - HSN DENTAL - CPT - 45391","HSN DENTAL - HSN DENTAL - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","HSN DENTAL","HSN DENTAL","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,456.36,420.34,2924,731]
["HSN DENTAL - HSN DENTAL - CPT - 81003","HSN DENTAL - HSN DENTAL - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","HSN DENTAL","HSN DENTAL","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,456.36,1.63,456.36,4.25]
["HSN DENTAL - HSN DENTAL - CPT - 99203","HSN DENTAL - HSN DENTAL - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","HSN DENTAL","HSN DENTAL","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,456.36,23.27,456.36,103.75]
["HSN DENTAL - HSN DENTAL - CPT - J1030","HSN DENTAL - HSN DENTAL - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","HSN DENTAL","HSN DENTAL","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,456.36,4.68,456.36,3.25]
["HSN DENTAL - HSN DENTAL - CPT - Q9967","HSN DENTAL - HSN DENTAL - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HSN DENTAL","HSN DENTAL","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,456.36000000000007,0.12,456.36,0.30555555555555558]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 81000","HSN PARTIAL - HSN PARTIAL STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","HSN PARTIAL","HSN PARTIAL STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,456.36,2.89,456.36,6]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - 85610","HSN PARTIAL - HSN PARTIAL STANDARD - 85610 - CHG PROTHROMBIN TIME","HSN PARTIAL","HSN PARTIAL STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,456.36,3.58,456.36,7.25]
["HSN PARTIAL - HSN PARTIAL STANDARD - CPT - A9513","HSN PARTIAL - HSN PARTIAL STANDARD - A9513 - DELETED 2077","HSN PARTIAL","HSN PARTIAL STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,456.36,154.44,456.36,107.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 29881","HSN PARTIAL - HSN PARTIAL TEMPORARY - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,456.36,420.34,5454,1363.5]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 45378","HSN PARTIAL - HSN PARTIAL TEMPORARY - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,456.35999999999996,395.43,2154,538.5]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 81002","HSN PARTIAL - HSN PARTIAL TEMPORARY - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,456.36,2.34,456.36,4.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 99203","HSN PARTIAL - HSN PARTIAL TEMPORARY - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,456.36,23.27,456.36,103.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - CPT - 99214","HSN PARTIAL - HSN PARTIAL TEMPORARY - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","HSN PARTIAL","HSN PARTIAL TEMPORARY","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,456.36,23.27,456.36,105.5]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 19120","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - 19120 - PR EXCISE BREAST CYST","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 76805","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - 90837","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - A9555","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - A9555 - PR RB82 RUBIDIUM","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - CPT - Q9967","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO - MASS GENERAL BRIG HLTH PLAN ACO STANDARD - CPT - 80053","MASS GENERAL BRIGHAM HEALTH PLAN ACO - MASS GENERAL BRIG HLTH PLAN ACO STANDARD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","MASS GENERAL BRIGHAM HEALTH PLAN ACO","MASS GENERAL BRIG HLTH PLAN ACO STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 45378","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1213.1300000000001,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 62323","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,836.35,420.34,1505.24,371.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 80076","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - 80076 - CHG HEPATIC FUNCTION PANEL","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,91.8,7.21,456.36,40.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - 99205","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - CPT - Q9967","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.68666666666666687,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 45378","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1213.1300000000001,395.43,2154,538.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 77065","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,423.53,102.59,752,188]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - 93452","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3580.83,420.34,6358,1589.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - A9579","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,2.2549999999999999,1.08,456.36,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - CPT - Q9967","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.68666666666666687,0.12,456.36,0.30555555555555558]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 66821","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - 66821 - PR DISCISSION,2ND CATARACT,LASER","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1583.16,420.34,2389.35,702.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 84443","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - 84443 - CHG ASSAY THYROID STIM HORMONE","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,64.2,14.82,456.36,28.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - 99385","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - 99385 - PR PREVENTIVE VISIT,NEW,18-39","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,298.5,23.27,530,132.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - CPT - Q9963","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.56000000000000005,0.22,456.36,0.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - CPT - 81001","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG COMMON - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG COMMON","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST - CPT - 85730","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST - 85730 - CHG THROMBOPLAS TIME PARTIAL","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGH HLTHPLAN MCD MNG CMA - CPT - 81002","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGH HLTHPLAN MCD MNG CMA - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGH HLTHPLAN MCD MNG CMA","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC - CPT - 84153","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.22,13.26,456.36,31.25]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG CARE - CPT - 85610","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED - MASS GEN BRIGHAM HLTH PLAN MCD MNG CARE - 85610 - CHG PROTHROMBIN TIME","MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG CARE","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE HMO - CPT - 81001","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE HMO - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE HMO","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.22,2.8,456.36,6]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1 - CPT - 81001","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1 - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.22,2.8,456.36,6]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - CPT - 80069","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - 80069 - CHG RENAL FUNCTION PANEL","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.81,7.66,456.36,48.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - CPT - 84153","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3 - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.649999999999999,13.26,456.36,31.25]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 66984","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,1252.56,420.34,4241.13,556]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 81002","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,9.57,2.34,456.36,4.25]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - 90834","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,121.09,27.84,456.36,53.75]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - CPT - A9513","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - A9513 - DELETED 2077","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,241.61,154.44,456.36,107.25]
["MEDICAID - CMSP STANDARD - CPT - 81002","MEDICAID - CMSP STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","MEDICAID","CMSP STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["MEDICAID - MEDICAID CARE PLUS - CPT - 85610","MEDICAID - MEDICAID CARE PLUS - 85610 - CHG PROTHROMBIN TIME","MEDICAID","MEDICAID CARE PLUS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["MEDICAID - MEDICAID CORRECTIONS IP - CPT - 80076","MEDICAID - MEDICAID CORRECTIONS IP - 80076 - CHG HEPATIC FUNCTION PANEL","MEDICAID","MEDICAID CORRECTIONS IP","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["MEDICAID - MEDICAID CORRECTIONS IP - CPT - 84443","MEDICAID - MEDICAID CORRECTIONS IP - 84443 - CHG ASSAY THYROID STIM HORMONE","MEDICAID","MEDICAID CORRECTIONS IP","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5]
["MEDICAID - MEDICAID EAEDC - CPT - 85610","MEDICAID - MEDICAID EAEDC - 85610 - CHG PROTHROMBIN TIME","MEDICAID","MEDICAID EAEDC","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["MEDICAID - MEDICAID SENIOR BUY-IN - CPT - 81003","MEDICAID - MEDICAID SENIOR BUY-IN - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","MEDICAID","MEDICAID SENIOR BUY-IN","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["MEDICAID - MEDICAID SENIOR BUY-IN - CPT - 85730","MEDICAID - MEDICAID SENIOR BUY-IN - 85730 - CHG THROMBOPLAS TIME PARTIAL","MEDICAID","MEDICAID SENIOR BUY-IN","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["MEDICAID ACO - MEDICAID ACO COMM - CPT - 80055","MEDICAID ACO - MEDICAID ACO COMM - 80055 - CHG OBSTETRIC PANEL","MEDICAID ACO","MEDICAID ACO COMM","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65]
["MEDICAID ACO - MEDICAID ACO MASS GENERAL BRIG - CPT - 81003","MEDICAID ACO - MEDICAID ACO MASS GENERAL BRIG - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","MEDICAID ACO","MEDICAID ACO MASS GENERAL BRIG","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["MEDICAID ACO - MEDICAID ACO STEWRD FAM ASSIS - CPT - 81000","MEDICAID ACO - MEDICAID ACO STEWRD FAM ASSIS - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","MEDICAID ACO","MEDICAID ACO STEWRD FAM ASSIS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - CPT - 81002","MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","MEDICAID ACO","ZZZMEDICAID ACO COMM CARE PLUS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - CPT - 85730","MEDICAID ACO - ZZZMEDICAID ACO COMM CARE PLUS - 85730 - CHG THROMBOPLAS TIME PARTIAL","MEDICAID ACO","ZZZMEDICAID ACO COMM CARE PLUS","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["MEDICAID ACO - ZZZMEDICAID ACO COMM FAM ASSIST - CPT - 81000","MEDICAID ACO - ZZZMEDICAID ACO COMM FAM ASSIST - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","MEDICAID ACO","ZZZMEDICAID ACO COMM FAM ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["MEDICAID ACO - ZZZMEDICAID ACO COMM STANDARD - CPT - 85025","MEDICAID ACO - ZZZMEDICAID ACO COMM STANDARD - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","MEDICAID ACO","ZZZMEDICAID ACO COMM STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS - CPT - 80061","MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS - 80061 - CHG LIPID PANEL","MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG COMMONHLT - CPT - 81000","MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG COMMONHLT - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG COMMONHLT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - CPT - 80069","MEDICAID ACO - ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD - 80069 - CHG RENAL FUNCTION PANEL","MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD CARE PLUS - CPT - 80061","MEDICAID ACO - ZZZMEDICAID ACO STEWRD CARE PLUS - 80061 - CHG LIPID PANEL","MEDICAID ACO","ZZZMEDICAID ACO STEWRD CARE PLUS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD COMMONHLT - CPT - 85025","MEDICAID ACO - ZZZMEDICAID ACO STEWRD COMMONHLT - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","MEDICAID ACO","ZZZMEDICAID ACO STEWRD COMMONHLT","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD FAM ASSIS - CPT - 80061","MEDICAID ACO - ZZZMEDICAID ACO STEWRD FAM ASSIS - 80061 - CHG LIPID PANEL","MEDICAID ACO","ZZZMEDICAID ACO STEWRD FAM ASSIS","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25]
["MEDICAID ACO - ZZZMEDICAID ACO STEWRD STANDARD - CPT - 85730","MEDICAID ACO - ZZZMEDICAID ACO STEWRD STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","MEDICAID ACO","ZZZMEDICAID ACO STEWRD STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["MEDICAID LIMITED - MEDICAID LIMITED LIMITED - CPT - 85730","MEDICAID LIMITED - MEDICAID LIMITED LIMITED - 85730 - CHG THROMBOPLAS TIME PARTIAL","MEDICAID LIMITED","MEDICAID LIMITED LIMITED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["MEDICAID MANAGED CARE - MCD MNG CARE CARE PLUS - CPT - 81001","MEDICAID MANAGED CARE - MCD MNG CARE CARE PLUS - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","MEDICAID MANAGED CARE","MCD MNG CARE CARE PLUS","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6]
["MEDICAID MANAGED CARE - MCD MNG CARE COMMONHEALTH - CPT - 81003","MEDICAID MANAGED CARE - MCD MNG CARE COMMONHEALTH - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","MEDICAID MANAGED CARE","MCD MNG CARE COMMONHEALTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["MEDICAID MANAGED CARE - MCD MNG CARE FAMILY ASSIST - CPT - 85610","MEDICAID MANAGED CARE - MCD MNG CARE FAMILY ASSIST - 85610 - CHG PROTHROMBIN TIME","MEDICAID MANAGED CARE","MCD MNG CARE FAMILY ASSIST","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["MEDICAID MANAGED CARE - MCD MNG CARE STANDARD - CPT - 81001","MEDICAID MANAGED CARE - MCD MNG CARE STANDARD - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","MEDICAID MANAGED CARE","MCD MNG CARE STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6]
["MEDICARE - MEDICARE A&B - CPT - 70553","MEDICARE - MEDICARE A&B - 70553 - CHG MRI BRAIN COMBO","MEDICARE","MEDICARE A&B","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["MEDICARE - MEDICARE A&B - CPT - 80069","MEDICARE - MEDICARE A&B - 80069 - CHG RENAL FUNCTION PANEL","MEDICARE","MEDICARE A&B","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,8.68,7.66,456.36,48.75]
["MEDICARE - MEDICARE A&B - CPT - 85730","MEDICARE - MEDICARE A&B - 85730 - CHG THROMBOPLAS TIME PARTIAL","MEDICARE","MEDICARE A&B","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["MEDICARE - MEDICARE A&B - CPT - A9579","MEDICARE - MEDICARE A&B - A9579 - GAD-BASE MR CONTRAST NOS,1ML","MEDICARE","MEDICARE A&B","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["MEDICARE - MEDICARE PART A ONLY - CPT - 45378","MEDICARE - MEDICARE PART A ONLY - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","MEDICARE","MEDICARE PART A ONLY","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["MEDICARE - MEDICARE PART A ONLY - CPT - 76830","MEDICARE - MEDICARE PART A ONLY - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","MEDICARE","MEDICARE PART A ONLY","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["MEDICARE - MEDICARE PART A ONLY - CPT - 84443","MEDICARE - MEDICARE PART A ONLY - 84443 - CHG ASSAY THYROID STIM HORMONE","MEDICARE","MEDICARE PART A ONLY","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,16.8,14.82,456.36,28.5]
["MEDICARE - MEDICARE PART A ONLY - CPT - 99212","MEDICARE - MEDICARE PART A ONLY - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","MEDICARE","MEDICARE PART A ONLY","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - 19120","MEDICARE - MEDICARE PART B ONLY - 19120 - PR EXCISE BREAST CYST","MEDICARE","MEDICARE PART B ONLY","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - 76700","MEDICARE - MEDICARE PART B ONLY - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","MEDICARE","MEDICARE PART B ONLY","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - 80048","MEDICARE - MEDICARE PART B ONLY - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","MEDICARE","MEDICARE PART B ONLY","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - 99203","MEDICARE - MEDICARE PART B ONLY - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","MEDICARE","MEDICARE PART B ONLY","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["MEDICARE - MEDICARE PART B ONLY - CPT - P9047","MEDICARE - MEDICARE PART B ONLY - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","MEDICARE","MEDICARE PART B ONLY","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["MEDICARE - MEDICARE PART B ONLY - CPT - Q9967","MEDICARE - MEDICARE PART B ONLY - Q9967 - LOCM 300-399MG/ML IODINE,1ML","MEDICARE","MEDICARE PART B ONLY","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 76805","MEDICARE - RAILROAD MEDICARE  RAILROAD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","MEDICARE","RAILROAD MEDICARE  RAILROAD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - 85730","MEDICARE - RAILROAD MEDICARE  RAILROAD - 85730 - CHG THROMBOPLAS TIME PARTIAL","MEDICARE","RAILROAD MEDICARE  RAILROAD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - A9513","MEDICARE - RAILROAD MEDICARE  RAILROAD - A9513 - DELETED 2077","MEDICARE","RAILROAD MEDICARE  RAILROAD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - CPT - Q9966","MEDICARE - RAILROAD MEDICARE  RAILROAD - Q9966 - LOCM 200-299MG/ML IODINE,1ML","MEDICARE","RAILROAD MEDICARE  RAILROAD","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 64483","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 84153","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - 99212","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - CPT - A9513","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - A9513 - DELETED 2077","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 45391","OXFORD HEALTH - OXFORD HEALTH STANDARD - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,2924,420.34,2924,731]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 77067","OXFORD HEALTH - OXFORD HEALTH STANDARD - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,162.43,108.47,488,122]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - 99204","OXFORD HEALTH - OXFORD HEALTH STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,328.17,23.27,705,176.25]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - P9047","OXFORD HEALTH - OXFORD HEALTH STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,138.30000000000001,50.13,456.36,45]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - CPT - Q9967","OXFORD HEALTH - OXFORD HEALTH STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","OXFORD HEALTH","OXFORD HEALTH STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 76805","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,272.94,113.99,1013.2,298]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 80061","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - 80061 - CHG LIPID PANEL","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,12.05,11.81,456.36,32.25]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - 90847","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,363,30.9,456.36,90.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - CPT - Q9963","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 62323","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,931.77,420.34,1505.24,371.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 77067","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,108.47,108.47,488,122]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - 99212","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,178.11,23.27,456.36,36.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - CPT - A9517","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - A9517 - PR I131 IODIDE CAP, RX","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,25.61,20.12,456.36,130.75]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 70553","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - 70553 - CHG MRI BRAIN COMBO","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,518.16,398.75,5879.45,1729.25]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 80055","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - 80055 - CHG OBSTETRIC PANEL","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,57.37,18.32,456.36,65]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 81003","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.7,1.63,456.36,4.25]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - 99205","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,178.11,23.27,899,224.75]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - CPT - Q9963","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 77067","TRICARE EAST - TRICARE EAST PRIME (HMO) - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,112.53,108.47,488,122]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 90837","TRICARE EAST - TRICARE EAST PRIME (HMO) - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,150.5,27.84,456.36,53.75]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - 99204","TRICARE EAST - TRICARE EAST PRIME (HMO) - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,137.06,23.27,705,176.25]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - CPT - J3301","TRICARE EAST - TRICARE EAST PRIME (HMO) - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TRICARE EAST","TRICARE EAST PRIME (HMO)","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 70553","TRICARE EAST - TRICARE EAST SELECT - 70553 - CHG MRI BRAIN COMBO","TRICARE EAST","TRICARE EAST SELECT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,398.75,398.75,5879.45,1729.25]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 76805","TRICARE EAST - TRICARE EAST SELECT - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","TRICARE EAST","TRICARE EAST SELECT","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,113.99,113.99,1013.2,298]
["TRICARE EAST - TRICARE EAST SELECT - CPT - 85730","TRICARE EAST - TRICARE EAST SELECT - 85730 - CHG THROMBOPLAS TIME PARTIAL","TRICARE EAST","TRICARE EAST SELECT","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,7.24,5.3,456.36,10.5]
["TRICARE EAST - TRICARE EAST SELECT - CPT - A9517","TRICARE EAST - TRICARE EAST SELECT - A9517 - PR I131 IODIDE CAP, RX","TRICARE EAST","TRICARE EAST SELECT","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.54,20.12,456.36,130.75]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 62323","TRICARE FOR LIFE - TRICARE FOR LIFE - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,717.03,420.34,1505.24,371.25]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 80069","TRICARE FOR LIFE - TRICARE FOR LIFE - 80069 - CHG RENAL FUNCTION PANEL","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,10.46,7.66,456.36,48.75]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 84153","TRICARE FOR LIFE - TRICARE FOR LIFE - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,22.16,13.26,456.36,31.25]
["TRICARE FOR LIFE - TRICARE FOR LIFE - CPT - 99385","TRICARE FOR LIFE - TRICARE FOR LIFE - 99385 - PR PREVENTIVE VISIT,NEW,18-39","TRICARE FOR LIFE","TRICARE FOR LIFE","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,101.62,23.27,530,132.5]
["TUFTS - TUFTS CARELINK - CPT - 19120","TUFTS - TUFTS CARELINK - 19120 - PR EXCISE BREAST CYST","TUFTS","TUFTS CARELINK","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,5615.19,420.34,6229.57,1049.75]
["TUFTS - TUFTS CARELINK - CPT - 45391","TUFTS - TUFTS CARELINK - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","TUFTS","TUFTS CARELINK","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1505.24,420.34,2924,731]
["TUFTS - TUFTS CARELINK - CPT - 77066","TUFTS - TUFTS CARELINK - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","TUFTS","TUFTS CARELINK","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,390.48,131.5,924,231]
["TUFTS - TUFTS CARELINK - CPT - 99203","TUFTS - TUFTS CARELINK - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","TUFTS","TUFTS CARELINK","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,27.28,23.27,456.36,103.75]
["TUFTS - TUFTS CARELINK - CPT - Q9967","TUFTS - TUFTS CARELINK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS","TUFTS CARELINK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS HMO - CPT - 66984","TUFTS - TUFTS HMO - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","TUFTS","TUFTS HMO","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,3587.95,420.34,4241.13,556]
["TUFTS - TUFTS HMO - CPT - 76700","TUFTS - TUFTS HMO - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","TUFTS","TUFTS HMO","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,332.11,111.92,961.35,282.75]
["TUFTS - TUFTS HMO - CPT - 85610","TUFTS - TUFTS HMO - 85610 - CHG PROTHROMBIN TIME","TUFTS","TUFTS HMO","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,29,3.58,456.36,7.25]
["TUFTS - TUFTS HMO - CPT - A9513","TUFTS - TUFTS HMO - A9513 - DELETED 2077","TUFTS","TUFTS HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,289.33999999999997,154.44,456.36,107.25]
["TUFTS - TUFTS HMO - CPT - J3301","TUFTS - TUFTS HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS","TUFTS HMO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["TUFTS - TUFTS POS - CPT - 66984","TUFTS - TUFTS POS - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","TUFTS","TUFTS POS","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,3587.95,420.34,4241.13,556]
["TUFTS - TUFTS POS - CPT - 81002","TUFTS - TUFTS POS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","TUFTS","TUFTS POS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.93,2.34,456.36,4.25]
["TUFTS - TUFTS POS - CPT - 99213","TUFTS - TUFTS POS - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","TUFTS","TUFTS POS","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,27.28,23.27,456.36,69.25]
["TUFTS - TUFTS POS - CPT - Q9967","TUFTS - TUFTS POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS","TUFTS POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS - TUFTS PPO - CPT - 55700","TUFTS - TUFTS PPO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","TUFTS","TUFTS PPO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1505.24,420.34,3848.68,587]
["TUFTS - TUFTS PPO - CPT - 76805","TUFTS - TUFTS PPO - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","TUFTS","TUFTS PPO","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,352.8,113.99,1013.2,298]
["TUFTS - TUFTS PPO - CPT - 90837","TUFTS - TUFTS PPO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","TUFTS","TUFTS PPO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,32.64,27.84,456.36,53.75]
["TUFTS - TUFTS PPO - CPT - 99204","TUFTS - TUFTS PPO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","TUFTS","TUFTS PPO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,27.28,23.27,705,176.25]
["TUFTS - TUFTS SELECT - CPT - 29881","TUFTS - TUFTS SELECT - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","TUFTS","TUFTS SELECT","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,5454,420.34,5454,1363.5]
["TUFTS - TUFTS SELECT - CPT - 70553","TUFTS - TUFTS SELECT - 70553 - CHG MRI BRAIN COMBO","TUFTS","TUFTS SELECT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,458.44,398.75,5879.45,1729.25]
["TUFTS - TUFTS SELECT - CPT - 85610","TUFTS - TUFTS SELECT - 85610 - CHG PROTHROMBIN TIME","TUFTS","TUFTS SELECT","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.43,3.58,456.36,7.25]
["TUFTS - TUFTS SELECT - CPT - 93452","TUFTS - TUFTS SELECT - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","TUFTS","TUFTS SELECT","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,6358,420.34,6358,1589.5]
["TUFTS - TUFTS SELECT - CPT - A9555","TUFTS - TUFTS SELECT - A9555 - PR RB82 RUBIDIUM","TUFTS","TUFTS SELECT","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["TUFTS - TUFTS SPIRIT - CPT - 45378","TUFTS - TUFTS SPIRIT - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","TUFTS","TUFTS SPIRIT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["TUFTS - TUFTS SPIRIT - CPT - 80055","TUFTS - TUFTS SPIRIT - 80055 - CHG OBSTETRIC PANEL","TUFTS","TUFTS SPIRIT","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,47.81,18.32,456.36,65]
["TUFTS - TUFTS SPIRIT - CPT - 90837","TUFTS - TUFTS SPIRIT - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","TUFTS","TUFTS SPIRIT","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,179.02,27.84,456.36,53.75]
["TUFTS - TUFTS SPIRIT - CPT - 99212","TUFTS - TUFTS SPIRIT - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","TUFTS","TUFTS SPIRIT","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,37.01,23.27,456.36,36.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 19120","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - 19120 - PR EXCISE BREAST CYST","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,420.34,420.34,6229.57,1049.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 74177","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,420.34,398.75,2773.55,815.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 85610","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - 85610 - CHG PROTHROMBIN TIME","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,5.12,3.58,456.36,7.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - 99203","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,420.34,23.27,456.36,103.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - CPT - J1030","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,420.34,4.68,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 66984","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,420.34,420.34,4241.13,556]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 81003","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.68,1.63,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - 85610","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - 85610 - CHG PROTHROMBIN TIME","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,5.12,3.58,456.36,7.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - A9513","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - A9513 - DELETED 2077","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,420.34,154.44,456.36,107.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - CPT - Q9967","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 80048","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,10.11,7.46,456.36,41.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 81002","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,4.16,2.34,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - 99203","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,420.34,23.27,456.36,103.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - CPT - Q9967","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 70553","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - 70553 - CHG MRI BRAIN COMBO","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,597.91999999999996,398.75,5879.45,1729.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 76805","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,170.93,113.99,1013.2,298]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - 90847","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,247.88,30.9,456.36,90.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - CPT - P9047","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,73.5,50.13,456.36,45]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 64483","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,420.34,420.34,1879.97,386.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 73721","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,420.34,254.07,4304.3999999999996,1266]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - 84443","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - 84443 - CHG ASSAY THYROID STIM HORMONE","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,20.079999999999998,14.82,456.36,28.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - A9575","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,420.34,0.13,456.36,2]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - CPT - Q9967","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 45385","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1834.71,420.34,2929.62,760]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 81000","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,5.57,2.89,456.36,6]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - 85730","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - 85730 - CHG THROMBOPLAS TIME PARTIAL","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,8.32,5.3,456.36,10.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - CPT - Q9967","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 45378","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,420.34,395.43,2154,538.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 80061","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - 80061 - CHG LIPID PANEL","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,16,11.81,456.36,32.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - 90847","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,420.34,30.9,456.36,90.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - A9555","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - A9555 - PR RB82 RUBIDIUM","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,420.34,420.34,1385,346.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - CPT - Q9963","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,420.34,0.22,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 77065","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,102.59,102.59,752,188]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - 81003","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,3.12,1.63,456.36,4.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - CPT - A9500","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - A9500 - PR TC99M SESTAMIBI","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 19120","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - 19120 - PR EXCISE BREAST CYST","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,420.34,420.34,6229.57,1049.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 76700","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,420.34,111.92,961.35,282.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 81001","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.79,2.8,456.36,6]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 99203","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,420.34,23.27,456.36,103.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - 99213","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,420.34,23.27,456.36,69.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - CPT - Q9967","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,420.34000000000003,0.12,456.36,0.30555555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 76700","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,170.93,111.92,961.35,282.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - 90846","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,247.88,30.9,456.36,77]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - A9575","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - CPT - Q9963","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 72193","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - 72193 - CHG CT SCAN OF PELVIS CONTRAST","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,420.34,190.5,2584,760]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 84153","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,21.97,13.26,456.36,31.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - 99214","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,420.34,23.27,456.36,105.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - CPT - A9579","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,420.34,1.08,456.36,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 45380","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1834.71,420.34,2575,643.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 80076","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - 80076 - CHG HEPATIC FUNCTION PANEL","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,11.31,7.21,456.36,40.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 81001","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,4.3899999999999997,2.8,456.36,6]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - CPT - 99213","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,69.23,23.27,456.36,69.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 43239","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,420.34,420.34,1871.88,428]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 76805","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,420.34,113.99,1013.2,298]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 81000","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.8099999999999996,2.89,456.36,6]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - 90847","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,420.34,30.9,456.36,90.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - CPT - Q9958","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,420.34,0.09,456.36,0.25]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 70553","TUFTS MEDICARE - TUFTS MEDICARE HMO - 70553 - CHG MRI BRAIN COMBO","TUFTS MEDICARE","TUFTS MEDICARE HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 76830","TUFTS MEDICARE - TUFTS MEDICARE HMO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","TUFTS MEDICARE","TUFTS MEDICARE HMO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - 85730","TUFTS MEDICARE - TUFTS MEDICARE HMO - 85730 - CHG THROMBOPLAS TIME PARTIAL","TUFTS MEDICARE","TUFTS MEDICARE HMO","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - CPT - A9579","TUFTS MEDICARE - TUFTS MEDICARE HMO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","TUFTS MEDICARE","TUFTS MEDICARE HMO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 62322","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 66821","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - 66821 - PR DISCISSION,2ND CATARACT,LASER","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,652.66,420.34,2389.35,702.75]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 81000","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.0199999999999996,2.89,456.36,6]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - 99212","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - CPT - J1030","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 76700","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,123.44,111.92,961.35,282.75]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 80048","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.4600000000000009,7.46,456.36,41.75]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - 90834","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - A9513","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - A9513 - DELETED 2077","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - CPT - Q9967","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 72110","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 85730","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - 85730 - CHG THROMBOPLAS TIME PARTIAL","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.01,5.3,456.36,10.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - CPT - 99214","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 45378","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 64483","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1023.42,420.34,1879.97,386.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 80076","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - 80076 - CHG HEPATIC FUNCTION PANEL","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - 99204","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - CPT - A9513","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - A9513 - DELETED 2077","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 29881","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 76805","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,123.44,113.99,1013.2,298]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - 99203","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - P9047","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,53.08,50.13,456.36,45]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - CPT - Q9967","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["TUFTS TOGETHER ACO - TUFTS TOGETHER ACO CHA - CPT - 85730","TUFTS TOGETHER ACO - TUFTS TOGETHER ACO CHA - 85730 - CHG THROMBOPLAS TIME PARTIAL","TUFTS TOGETHER ACO","TUFTS TOGETHER ACO CHA","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS - CPT - 81003","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS - CPT - 80048","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH - CPT - 80069","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH - 80069 - CHG RENAL FUNCTION PANEL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST - CPT - 85610","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST - 85610 - CHG PROTHROMBIN TIME","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH - CPT - 80048","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH CARE PLUS - CPT - 81003","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH CARE PLUS - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH CARE PLUS","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH COMMONHLTH - CPT - 80048","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH COMMONHLTH - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH COMMONHLTH","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH FAM ASSIST - CPT - 81003","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH FAM ASSIST - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH FAM ASSIST","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH STANDARD - CPT - 85610","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BCH STANDARD - 85610 - CHG PROTHROMBIN TIME","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO - CPT - 80076","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO - 80076 - CHG HEPATIC FUNCTION PANEL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS - CPT - 81002","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST - CPT - 81002","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO STANDARD - CPT - 80076","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO BIDCO STANDARD - 80076 - CHG HEPATIC FUNCTION PANEL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA CARE PLUS - CPT - 85610","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA CARE PLUS - 85610 - CHG PROTHROMBIN TIME","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA CARE PLUS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA COMMONHLTH - CPT - 81003","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA COMMONHLTH - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA COMMONHLTH","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,1.98,1.63,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA FAM ASSIST - CPT - 81002","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO CHA FAM ASSIST - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA FAM ASSIST","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY - CPT - 80053","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS - CPT - 80076","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS - 80076 - CHG HEPATIC FUNCTION PANEL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY COMMONHLTH - CPT - 80076","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY COMMONHLTH - 80076 - CHG HEPATIC FUNCTION PANEL","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY COMMONHLTH","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.21,7.21,456.36,40.75]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST - CPT - 81000","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY STANDARD - CPT - 81002","TUFTS TOGETHER ACO - ZZZTUFTS TOGETHER ACO LAHEY STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO CARE PLUS - CPT - 80053","TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO CARE PLUS - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO CARE PLUS","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - CPT - 80061","TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - 80061 - CHG LIPID PANEL","TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO FAMILY ASSIST","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25]
["TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - CPT - 85025","TUFTS TOGETHER MCO - ZZZTUFTS TOGETHER MCO FAMILY ASSIST - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO FAMILY ASSIST","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75]
["UBH HPHC - UBH HPHC - CPT - 45378","UBH HPHC - UBH HPHC - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","UBH HPHC","UBH HPHC","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["UBH HPHC - UBH HPHC - CPT - 76830","UBH HPHC - UBH HPHC - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","UBH HPHC","UBH HPHC","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["UBH HPHC - UBH HPHC - CPT - 90834","UBH HPHC - UBH HPHC - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","UBH HPHC","UBH HPHC","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,179.02,27.84,456.36,53.75]
["UBH HPHC - UBH HPHC - CPT - 99212","UBH HPHC - UBH HPHC - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","UBH HPHC","UBH HPHC","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,148.41999999999999,23.27,456.36,36.75]
["UBH HPHC - UBH HPHC - CPT - Q9967","UBH HPHC - UBH HPHC - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UBH HPHC","UBH HPHC","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNICARE - UNICARE STANDARD - CPT - 74177","UNICARE - UNICARE STANDARD - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","UNICARE","UNICARE STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,2447.25,398.75,2773.55,815.75]
["UNICARE - UNICARE STANDARD - CPT - 76830","UNICARE - UNICARE STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","UNICARE","UNICARE STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,132.9,113.99,873.8,257]
["UNICARE - UNICARE STANDARD - CPT - 90834","UNICARE - UNICARE STANDARD - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","UNICARE","UNICARE STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,161.25,27.84,456.36,53.75]
["UNICARE - UNICARE STANDARD - CPT - J1030","UNICARE - UNICARE STANDARD - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","UNICARE","UNICARE STANDARD","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.67,4.68,456.36,3.25]
["UNITED - UNITED DEFINITY HRA - CPT - 45380","UNITED - UNITED DEFINITY HRA - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","UNITED","UNITED DEFINITY HRA","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,2575,420.34,2575,643.75]
["UNITED - UNITED DEFINITY HRA - CPT - 70553","UNITED - UNITED DEFINITY HRA - 70553 - CHG MRI BRAIN COMBO","UNITED","UNITED DEFINITY HRA","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,954.74,398.75,5879.45,1729.25]
["UNITED - UNITED DEFINITY HRA - CPT - 85610","UNITED - UNITED DEFINITY HRA - 85610 - CHG PROTHROMBIN TIME","UNITED","UNITED DEFINITY HRA","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.86,3.58,456.36,7.25]
["UNITED - UNITED DEFINITY HRA - CPT - 99213","UNITED - UNITED DEFINITY HRA - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","UNITED","UNITED DEFINITY HRA","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["UNITED - UNITED HP SHIP - CPT - 43239","UNITED - UNITED HP SHIP - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","UNITED","UNITED HP SHIP","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1871.88,420.34,1871.88,428]
["UNITED - UNITED HP SHIP - CPT - 76805","UNITED - UNITED HP SHIP - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","UNITED","UNITED HP SHIP","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298]
["UNITED - UNITED HP SHIP - CPT - 80061","UNITED - UNITED HP SHIP - 80061 - CHG LIPID PANEL","UNITED","UNITED HP SHIP","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,40.630000000000003,11.81,456.36,32.25]
["UNITED - UNITED HP SHIP - CPT - 99204","UNITED - UNITED HP SHIP - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","UNITED","UNITED HP SHIP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25]
["UNITED - UNITED HP SHIP - CPT - Q9967","UNITED - UNITED HP SHIP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED","UNITED HP SHIP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED - UNITED HP SHIP - CPT - Q9967","UNITED - UNITED HP SHIP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED","UNITED HP SHIP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 76830","UNITED - UNITED HP STUDENT HEALTH - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","UNITED","UNITED HP STUDENT HEALTH","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,220.4,113.99,873.8,257]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 85730","UNITED - UNITED HP STUDENT HEALTH - 85730 - CHG THROMBOPLAS TIME PARTIAL","UNITED","UNITED HP STUDENT HEALTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,16.39,5.3,456.36,10.5]
["UNITED - UNITED HP STUDENT HEALTH - CPT - 99204","UNITED - UNITED HP STUDENT HEALTH - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","UNITED","UNITED HP STUDENT HEALTH","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25]
["UNITED - UNITED NAVIGATE - CPT - 45378","UNITED - UNITED NAVIGATE - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","UNITED","UNITED NAVIGATE","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,2154,395.43,2154,538.5]
["UNITED - UNITED NAVIGATE - CPT - 62323","UNITED - UNITED NAVIGATE - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","UNITED","UNITED NAVIGATE","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1485,420.34,1505.24,371.25]
["UNITED - UNITED NAVIGATE - CPT - 85027","UNITED - UNITED NAVIGATE - 85027 - CHG COMPLETE CBC","UNITED","UNITED NAVIGATE","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,5.82,5.71,456.36,11.25]
["UNITED - UNITED NAVIGATE - CPT - 99205","UNITED - UNITED NAVIGATE - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","UNITED","UNITED NAVIGATE","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,328.17,23.27,899,224.75]
["UNITED - UNITED NAVIGATE - CPT - A9500","UNITED - UNITED NAVIGATE - A9500 - PR TC99M SESTAMIBI","UNITED","UNITED NAVIGATE","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["UNITED - UNITED PASSPORT CONNECT - CPT - 45385","UNITED - UNITED PASSPORT CONNECT - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","UNITED","UNITED PASSPORT CONNECT","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760]
["UNITED - UNITED PASSPORT CONNECT - CPT - 81001","UNITED - UNITED PASSPORT CONNECT - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","UNITED","UNITED PASSPORT CONNECT","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,8.65,2.8,456.36,6]
["UNITED - UNITED PASSPORT CONNECT - CPT - 97110","UNITED - UNITED PASSPORT CONNECT - 97110 - PR THERAPEUTIC EXERCISES","UNITED","UNITED PASSPORT CONNECT","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,145.28,23.1,456.36,62.25]
["UNITED - UNITED PASSPORT CONNECT - CPT - A9581","UNITED - UNITED PASSPORT CONNECT - A9581 - PR GADOXETATE DISODIUM INJ","UNITED","UNITED PASSPORT CONNECT","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["UNITED - UNITED PASSPORT CONNECT - CPT - Q9967","UNITED - UNITED PASSPORT CONNECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED","UNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED - UNITED STANDARD - CPT - 62322","UNITED - UNITED STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","UNITED","UNITED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["UNITED - UNITED STANDARD - CPT - 85027","UNITED - UNITED STANDARD - 85027 - CHG COMPLETE CBC","UNITED","UNITED STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,5.82,5.71,456.36,11.25]
["UNITED - UNITED STANDARD - CPT - 90834","UNITED - UNITED STANDARD - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","UNITED","UNITED STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,215,27.84,456.36,53.75]
["UNITED - UNITED STANDARD - CPT - A9552","UNITED - UNITED STANDARD - A9552 - PR F18 FDG","UNITED","UNITED STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 45378","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 81002","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 99204","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,148.41999999999999,23.27,705,176.25]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - CPT - 99214","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 19120","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - 19120 - PR EXCISE BREAST CYST","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 76830","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - 80076","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - 80076 - CHG HEPATIC FUNCTION PANEL","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,8.17,7.21,456.36,40.75]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - A9552","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - A9552 - PR F18 FDG","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - CPT - Q9967","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 74177","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,431.8,398.75,2773.55,815.75]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 85025","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - 90662","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,36.119999999999997,36.119999999999997,456.36,32.25]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - CPT - A9552","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - A9552 - PR F18 FDG","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 55700","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 70553","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - 70553 - CHG MRI BRAIN COMBO","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 84153","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,18.39,13.26,456.36,31.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - CPT - 99214","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 45378","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1026.2,395.43,2154,538.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 76830","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,123.44,113.99,873.8,257]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 81002","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - 93452","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - CPT - Q9967","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 19120","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - 19120 - PR EXCISE BREAST CYST","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4279.8500000000004,420.34,6229.57,1049.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 80053","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - 90832","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,179.02,21.97,456.36,42]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - J3301","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - CPT - Q9967","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 70553","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - 70553 - CHG MRI BRAIN COMBO","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,431.8,398.75,5879.45,1729.25]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 81002","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - 99214","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,148.41999999999999,23.27,456.36,105.5]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - CPT - Q9963","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 45378","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,861.6,395.43,2154,538.5]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 80069","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - 80069 - CHG RENAL FUNCTION PANEL","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,78,7.66,456.36,48.75]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - 90853","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - 90853 - PR GROUP PSYCHOTHERAPY","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,51.6,15.63,456.36,32.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - A9555","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - A9555 - PR RB82 RUBIDIUM","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,554,420.34,1385,346.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - CPT - Q9967","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.48888888888888882,0.12,456.36,0.30555555555555558]
["WELLCARE - WELLCARE HMO - CPT - 72193","WELLCARE - WELLCARE HMO - 72193 - CHG CT SCAN OF PELVIS CONTRAST","WELLCARE","WELLCARE HMO","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,214.55,190.5,2584,760]
["WELLCARE - WELLCARE HMO - CPT - 90715","WELLCARE - WELLCARE HMO - 90715 - PR TDAP VACCINE >7 YO, IM","WELLCARE","WELLCARE HMO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["WELLCARE - WELLCARE HMO - CPT - A9517","WELLCARE - WELLCARE HMO - A9517 - PR I131 IODIDE CAP, RX","WELLCARE","WELLCARE HMO","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,22.19,20.12,456.36,130.75]
["WELLCARE - WELLCARE HMO - CPT - P9047","WELLCARE - WELLCARE HMO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","WELLCARE","WELLCARE HMO","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,55.2,50.13,456.36,45]
["WELLCARE - WELLCARE PPO - CPT - 70553","WELLCARE - WELLCARE PPO - 70553 - CHG MRI BRAIN COMBO","WELLCARE","WELLCARE PPO","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,449.08,398.75,5879.45,1729.25]
["WELLCARE - WELLCARE PPO - CPT - 80055","WELLCARE - WELLCARE PPO - 80055 - CHG OBSTETRIC PANEL","WELLCARE","WELLCARE PPO","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,49.72,18.32,456.36,65]
["WELLCARE - WELLCARE PPO - CPT - 99215","WELLCARE - WELLCARE PPO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","WELLCARE","WELLCARE PPO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,154.36000000000001,23.27,595,148.75]
["WELLCARE - WELLCARE PPO - CPT - A9579","WELLCARE - WELLCARE PPO - A9579 - GAD-BASE MR CONTRAST NOS,1ML","WELLCARE","WELLCARE PPO","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["WELLCARE - WELLCARE STANDARD - CPT - 45380","WELLCARE - WELLCARE STANDARD - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","WELLCARE","WELLCARE STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1377.99,420.34,2575,643.75]
["WELLCARE - WELLCARE STANDARD - CPT - 80048","WELLCARE - WELLCARE STANDARD - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","WELLCARE","WELLCARE STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.8000000000000007,7.46,456.36,41.75]
["WELLCARE - WELLCARE STANDARD - CPT - 99203","WELLCARE - WELLCARE STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","WELLCARE","WELLCARE STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,154.36000000000001,23.27,456.36,103.75]
["WELLCARE - WELLCARE STANDARD - CPT - 99213","WELLCARE - WELLCARE STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","WELLCARE","WELLCARE STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,154.36000000000001,23.27,456.36,69.25]
["WELLSENSE - WELLSENSE CHOICE - CPT - 80061","WELLSENSE - WELLSENSE CHOICE - 80061 - CHG LIPID PANEL","WELLSENSE","WELLSENSE CHOICE","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,14.17,11.81,456.36,32.25]
["WELLSENSE - WELLSENSE CLARITY BRONZE - CPT - 81001","WELLSENSE - WELLSENSE CLARITY BRONZE - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","WELLSENSE","WELLSENSE CLARITY BRONZE","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.36,2.8,456.36,6]
["WELLSENSE - WELLSENSE CLARITY GOLD - CPT - 85730","WELLSENSE - WELLSENSE CLARITY GOLD - 85730 - CHG THROMBOPLAS TIME PARTIAL","WELLSENSE","WELLSENSE CLARITY GOLD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,6.36,5.3,456.36,10.5]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 1 - CPT - 81001","WELLSENSE - WELLSENSE CLARITY PLAN TYPE 1 - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","WELLSENSE","WELLSENSE CLARITY PLAN TYPE 1","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.36,2.8,456.36,6]
["WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - CPT - 81003","WELLSENSE - WELLSENSE CLARITY PLAN TYPE 2 - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","WELLSENSE","WELLSENSE CLARITY PLAN TYPE 2","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.38,1.63,456.36,4.25]
["WELLSENSE - WELLSENSE CLARITY PLATINUM - CPT - 81000","WELLSENSE - WELLSENSE CLARITY PLATINUM - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","WELLSENSE","WELLSENSE CLARITY PLATINUM","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.26,2.89,456.36,6]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 81001","WELLSENSE - WELLSENSE CLARITY SILVER - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","WELLSENSE","WELLSENSE CLARITY SILVER","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,3.36,2.8,456.36,6]
["WELLSENSE - WELLSENSE CLARITY SILVER - CPT - 85610","WELLSENSE - WELLSENSE CLARITY SILVER - 85610 - CHG PROTHROMBIN TIME","WELLSENSE","WELLSENSE CLARITY SILVER","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.54,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - CPT - 81001","WELLSENSE ALLI ACO - WELLSENSE ALLI ACO CHILDRENS - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO CHILDRENS","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - CPT - 80048","WELLSENSE ALLI ACO - WELLSENSE ALLI ACO EAST BOSTON - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO EAST BOSTON","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.46,7.46,456.36,41.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 80069","WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - 80069 - CHG RENAL FUNCTION PANEL","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO MERCY","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.66,7.66,456.36,48.75]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - CPT - 84153","WELLSENSE ALLI ACO - WELLSENSE ALLI ACO MERCY - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO MERCY","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.22,13.26,456.36,31.25]
["WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - CPT - 80053","WELLSENSE ALLI ACO - WELLSENSE ALLI ACO SOUTH COAST - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","WELLSENSE ALLI ACO","WELLSENSE ALLI ACO SOUTH COAST","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - CPT - 81002","WELLSENSE ALLI ACO - WELLSENSE CARE ALLIANCE - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WELLSENSE ALLI ACO","WELLSENSE CARE ALLIANCE","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - CPT - 84153","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM CARE PLUS - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM CARE PLUS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.22,13.26,456.36,31.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - CPT - 80053","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM COMMONHLTH - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM COMMONHLTH","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.31,9.31,456.36,67.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - CPT - 85730","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM FAM ASSIST - 85730 - CHG THROMBOPLAS TIME PARTIAL","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM FAM ASSIST","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - CPT - 85610","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO COMM STANDARD - 85610 - CHG PROTHROMBIN TIME","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81002","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY COMMONHLTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - CPT - 81002","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY COMMONHLTH - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY COMMONHLTH","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.07,2.34,456.36,4.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - CPT - 84443","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO LAHEY STANDARD - 84443 - CHG ASSAY THYROID STIM HORMONE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - CPT - 84443","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY CARE PLUS - 84443 - CHG ASSAY THYROID STIM HORMONE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY CARE PLUS","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - CPT - 85610","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY COMMONHLTH - 85610 - CHG PROTHROMBIN TIME","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY COMMONHLTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.78,3.58,456.36,7.25]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - CPT - 81000","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY FAM ASSIST - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY FAM ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - CPT - 81001","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO MERCY STANDARD - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.8,2.8,456.36,6]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - CPT - 80055","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG COMMONHLTH - 80055 - CHG OBSTETRIC PANEL","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG COMMONHLTH","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 84443","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - 84443 - CHG ASSAY THYROID STIM HORMONE","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG FAM ASSIST","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,14.82,14.82,456.36,28.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - CPT - 85025","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO SIG FAM ASSIST - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG FAM ASSIST","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.85,6.85,456.36,13.75]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - CPT - 80055","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO CARE PLUS - 80055 - CHG OBSTETRIC PANEL","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO CARE PLUS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - CPT - 85730","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO COMMNHLTH - 85730 - CHG THROMBOPLAS TIME PARTIAL","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO COMMNHLTH","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - CPT - 80055","WELLSENSE ALLI ACO - ZZZBMC HP ALLI ACO STH CO STANDARD - 80055 - CHG OBSTETRIC PANEL","WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,42.17,18.32,456.36,65]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - CPT - 81000","WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO CARE PLUS - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO CARE PLUS","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - CPT - 80061","WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO COMMONHEALTH - 80061 - CHG LIPID PANEL","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO COMMONHEALTH","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,11.81,11.81,456.36,32.25]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - CPT - 81000","WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO FAMILY ASSIST - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO FAMILY ASSIST","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.55,2.89,456.36,6]
["WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - CPT - 85730","WELLSENSE ESSENTIAL MCO - WELLSENSE ESSENTIAL MCO STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.3,5.3,456.36,10.5]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 72148","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - 72148 - CHG MRI, LUMBAR SPINE","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,1667.88,254.07,3938.05,1158.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 77066","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,332.64,131.5,924,231]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - 95810","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,1416.6,420.34,3344.75,983.75]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - A9579","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - A9579 - GAD-BASE MR CONTRAST NOS,1ML","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,1.44,1.08,456.36,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - CPT - Q9967","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.43999999999999989,0.12,456.36,0.30555555555555558]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 66984","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2616.5500000000002,420.34,4241.13,556]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - 85025","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,7.77,6.85,456.36,13.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - A9513","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - A9513 - DELETED 2077","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,290.44,154.44,456.36,107.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - CPT - A9581","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - A9581 - PR GADOXETATE DISODIUM INJ","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 55700","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 81002","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.48,2.34,456.36,4.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - 99203","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - A9555","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - A9555 - PR RB82 RUBIDIUM","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - CPT - Q9967","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 76830","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,131.47999999999999,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 81001","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,4.43,2.8,456.36,6]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - 93452","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,2717.41,420.34,6358,1589.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - CPT - Q9963","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.43,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 62323","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,634.69000000000005,420.34,1505.24,371.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 77066","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,394.92,131.5,924,231]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 90686","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,31.63,19.16,456.36,18.5]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - CPT - 99385","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - 99385 - PR PREVENTIVE VISIT,NEW,18-39","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,226.52,23.27,530,132.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 45378","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 76700","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,111.92,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 81000","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.43,2.89,456.36,6]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - 99212","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,41.58,23.27,456.36,36.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - CPT - Q9966","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - Q9966 - LOCM 200-299MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,0.43,0.36,456.36,0.25]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 66984","WORKERS COMP - WORKERS COMP CCMSI - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","WORKERS COMP","WORKERS COMP CCMSI","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,950.54,420.34,4241.13,556]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 77066","WORKERS COMP - WORKERS COMP CCMSI - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","WORKERS COMP","WORKERS COMP CCMSI","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,394.92,131.5,924,231]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 90715","WORKERS COMP - WORKERS COMP CCMSI - 90715 - PR TDAP VACCINE >7 YO, IM","WORKERS COMP","WORKERS COMP CCMSI","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,76.930000000000007,39.75,456.36,45]
["WORKERS COMP - WORKERS COMP CCMSI - CPT - 99215","WORKERS COMP - WORKERS COMP CCMSI - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","WORKERS COMP","WORKERS COMP CCMSI","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,132.82,23.27,595,148.75]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 66821","WORKERS COMP - WORKERS COMP CITY OF BOSTON - 66821 - PR DISCISSION,2ND CATARACT,LASER","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1201.42,420.34,2389.35,702.75]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 66984","WORKERS COMP - WORKERS COMP CITY OF BOSTON - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,950.54,420.34,4241.13,556]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 85025","WORKERS COMP - WORKERS COMP CITY OF BOSTON - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,10.86,6.85,456.36,13.75]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - CPT - 99204","WORKERS COMP - WORKERS COMP CITY OF BOSTON - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","WORKERS COMP","WORKERS COMP CITY OF BOSTON","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 19120","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - 19120 - PR EXCISE BREAST CYST","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,1794.65,420.34,6229.57,1049.75]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 45391","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,1249.72,420.34,2924,731]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 77067","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,208.57,108.47,488,122]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - 93452","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,2717.41,420.34,6358,1589.5]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - J1030","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,5.56,4.68,456.36,3.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - CPT - Q9967","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 76700","WORKERS COMP - WORKERS COMP COVE RISK - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","WORKERS COMP","WORKERS COMP COVE RISK","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,111.92,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - 85730","WORKERS COMP - WORKERS COMP COVE RISK - 85730 - CHG THROMBOPLAS TIME PARTIAL","WORKERS COMP","WORKERS COMP COVE RISK","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,8.3800000000000008,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - A9513","WORKERS COMP - WORKERS COMP COVE RISK - A9513 - DELETED 2077","WORKERS COMP","WORKERS COMP COVE RISK","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,183.35,154.44,456.36,107.25]
["WORKERS COMP - WORKERS COMP COVE RISK - CPT - J3301","WORKERS COMP - WORKERS COMP COVE RISK - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","WORKERS COMP","WORKERS COMP COVE RISK","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,7.69,0.98,456.36,4.5]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 55700","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1003.54,420.34,3848.68,587]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 84443","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - 84443 - CHG ASSAY THYROID STIM HORMONE","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,23.47,14.82,456.36,28.5]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 99203","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,100,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - CPT - 99214","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,98.77,23.27,456.36,105.5]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 45378","WORKERS COMP - WORKERS COMP GUARD INSURANCE - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 76805","WORKERS COMP - WORKERS COMP GUARD INSURANCE - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,114.99,113.99,1013.2,298]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 90837","WORKERS COMP - WORKERS COMP GUARD INSURANCE - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,91.89,27.84,456.36,53.75]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - 99204","WORKERS COMP - WORKERS COMP GUARD INSURANCE - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - CPT - Q9967","WORKERS COMP - WORKERS COMP GUARD INSURANCE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP GUARD INSURANCE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 70553","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - 70553 - CHG MRI BRAIN COMBO","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,2956.33,398.75,5879.45,1729.25]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 81002","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.57,2.34,456.36,4.25]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - 85730","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - 85730 - CHG THROMBOPLAS TIME PARTIAL","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,8.3800000000000008,5.3,456.36,10.5]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - CPT - Q9963","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.43,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 45378","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,395.43,395.43,2154,538.5]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 80055","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - 80055 - CHG OBSTETRIC PANEL","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,111.12,18.32,456.36,65]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - 90846","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,131.63999999999999,30.9,456.36,77]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - A9552","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - A9552 - PR F18 FDG","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,433.81,365.4,1015,253.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - CPT - Q9967","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 72110","WORKERS COMP - WORKERS COMP MBTA - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","WORKERS COMP","WORKERS COMP MBTA","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,46.45,46.45,595,148.75]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 76830","WORKERS COMP - WORKERS COMP MBTA - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","WORKERS COMP","WORKERS COMP MBTA","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,131.47999999999999,113.99,873.8,257]
["WORKERS COMP - WORKERS COMP MBTA - CPT - 90662","WORKERS COMP - WORKERS COMP MBTA - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","WORKERS COMP","WORKERS COMP MBTA","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,55.13,36.119999999999997,456.36,32.25]
["WORKERS COMP - WORKERS COMP MBTA - CPT - A9575","WORKERS COMP - WORKERS COMP MBTA - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","WORKERS COMP","WORKERS COMP MBTA","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,3.42,0.13,456.36,2]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 62322","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,609.47,82.95,1426,356.5]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 77065","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,321.39999999999998,102.59,752,188]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 84153","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,25.7,13.26,456.36,31.25]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - 99215","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,132.82,23.27,595,148.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - CPT - Q9967","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 76700","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,111.92,111.92,961.35,282.75]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 77065","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,321.39999999999998,102.59,752,188]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - 93452","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,2717.41,420.34,6358,1589.5]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - CPT - Q9963","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,0.43,0.22,456.36,0.25]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 66821","WORKERS COMP - WORKERS COMP STANDARD - 66821 - PR DISCISSION,2ND CATARACT,LASER","WORKERS COMP","WORKERS COMP STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1201.42,420.34,2389.35,702.75]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 73721","WORKERS COMP - WORKERS COMP STANDARD - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","WORKERS COMP","WORKERS COMP STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,578.29999999999995,254.07,4304.3999999999996,1266]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 90686","WORKERS COMP - WORKERS COMP STANDARD - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","WORKERS COMP","WORKERS COMP STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,31.63,19.16,456.36,18.5]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - 99385","WORKERS COMP - WORKERS COMP STANDARD - 99385 - PR PREVENTIVE VISIT,NEW,18-39","WORKERS COMP","WORKERS COMP STANDARD","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,226.52,23.27,530,132.5]
["WORKERS COMP - WORKERS COMP STANDARD - CPT - J3301","WORKERS COMP - WORKERS COMP STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","WORKERS COMP","WORKERS COMP STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,7.69,0.98,456.36,4.5]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 45385","WORKERS COMP - WORKERS COMP THE HARTFORD - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1299.3,420.34,2929.62,760]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 81000","WORKERS COMP - WORKERS COMP THE HARTFORD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,4.43,2.89,456.36,6]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - 99212","WORKERS COMP - WORKERS COMP THE HARTFORD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,41.58,23.27,456.36,36.75]
["WORKERS COMP - WORKERS COMP THE HARTFORD - CPT - Q9967","WORKERS COMP - WORKERS COMP THE HARTFORD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP THE HARTFORD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 19120","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - 19120 - PR EXCISE BREAST CYST","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,1794.65,420.34,6229.57,1049.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 77066","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,394.92,131.5,924,231]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 90853","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - 90853 - PR GROUP PSYCHOTHERAPY","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,55.13,15.63,456.36,32.25]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - 99203","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,100,23.27,456.36,103.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - CPT - J1030","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,5.56,4.68,456.36,3.25]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 66984","WORKERS COMP - ZZZWORKERS COMP AIG - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","WORKERS COMP","ZZZWORKERS COMP AIG","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,950.54,420.34,4241.13,556]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 77066","WORKERS COMP - ZZZWORKERS COMP AIG - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","WORKERS COMP","ZZZWORKERS COMP AIG","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,394.92,131.5,924,231]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - 99213","WORKERS COMP - ZZZWORKERS COMP AIG - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","WORKERS COMP","ZZZWORKERS COMP AIG","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,65.91,23.27,456.36,69.25]
["WORKERS COMP - ZZZWORKERS COMP AIG - CPT - A9513","WORKERS COMP - ZZZWORKERS COMP AIG - A9513 - DELETED 2077","WORKERS COMP","ZZZWORKERS COMP AIG","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,183.35,154.44,456.36,107.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 29881","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,2331.04,420.34,5454,1363.5]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 72193","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - 72193 - CHG CT SCAN OF PELVIS CONTRAST","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,332.53,190.5,2584,760]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 81002","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.57,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - 99203","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,100,23.27,456.36,103.75]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - CPT - Q9967","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333343,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 66984","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,950.54,420.34,4241.13,556]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 85610","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - 85610 - CHG PROTHROMBIN TIME","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,5.49,3.58,456.36,7.25]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - 90837","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,91.89,27.84,456.36,53.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - CPT - Q9967","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 55700","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,1003.54,420.34,3848.68,587]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 70553","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - 70553 - CHG MRI BRAIN COMBO","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,2956.33,398.75,5879.45,1729.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 81002","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.57,2.34,456.36,4.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - 99204","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - CPT - Q9967","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 76805","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,114.99,113.99,1013.2,298]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 80055","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - 80055 - CHG OBSTETRIC PANEL","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,111.12,18.32,456.36,65]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - 90837","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,91.89,27.84,456.36,53.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - Q9958","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,0.43,0.09,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - CPT - Q9967","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 72110","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,46.45,46.45,595,148.75]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 85730","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - 85730 - CHG THROMBOPLAS TIME PARTIAL","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,8.3800000000000008,5.3,456.36,10.5]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - CPT - 99215","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,132.82,23.27,595,148.75]
["ZZZAETNA - ZZZAETNA HMO - CPT - 45378","ZZZAETNA - ZZZAETNA HMO - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","ZZZAETNA","ZZZAETNA HMO","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,1592.25,395.43,2154,538.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - 62322","ZZZAETNA - ZZZAETNA HMO - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","ZZZAETNA","ZZZAETNA HMO","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,754.35,82.95,1426,356.5]
["ZZZAETNA - ZZZAETNA HMO - CPT - 81002","ZZZAETNA - ZZZAETNA HMO - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","ZZZAETNA","ZZZAETNA HMO","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.99,2.34,456.36,4.25]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99205","ZZZAETNA - ZZZAETNA HMO - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","ZZZAETNA","ZZZAETNA HMO","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["ZZZAETNA - ZZZAETNA HMO - CPT - 99215","ZZZAETNA - ZZZAETNA HMO - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","ZZZAETNA","ZZZAETNA HMO","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,314.76,23.27,595,148.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 19120","ZZZAETNA - ZZZAETNA MCR SUPP - 19120 - PR EXCISE BREAST CYST","ZZZAETNA","ZZZAETNA MCR SUPP","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,2221.27,420.34,6229.57,1049.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 76830","ZZZAETNA - ZZZAETNA MCR SUPP - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZAETNA","ZZZAETNA MCR SUPP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,543.80999999999995,113.99,873.8,257]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - 90662","ZZZAETNA - ZZZAETNA MCR SUPP - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","ZZZAETNA","ZZZAETNA MCR SUPP","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,68.239999999999995,36.119999999999997,456.36,32.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - A9575","ZZZAETNA - ZZZAETNA MCR SUPP - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","ZZZAETNA","ZZZAETNA MCR SUPP","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["ZZZAETNA - ZZZAETNA MCR SUPP - CPT - Q9967","ZZZAETNA - ZZZAETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZAETNA","ZZZAETNA MCR SUPP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZAETNA - ZZZAETNA POS - CPT - 64483","ZZZAETNA - ZZZAETNA POS - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","ZZZAETNA","ZZZAETNA POS","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,817.31,420.34,1879.97,386.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 84153","ZZZAETNA - ZZZAETNA POS - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","ZZZAETNA","ZZZAETNA POS","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,66.13,13.26,456.36,31.25]
["ZZZAETNA - ZZZAETNA POS - CPT - 99205","ZZZAETNA - ZZZAETNA POS - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","ZZZAETNA","ZZZAETNA POS","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,475.57,23.27,899,224.75]
["ZZZAETNA - ZZZAETNA POS - CPT - J1030","ZZZAETNA - ZZZAETNA POS - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","ZZZAETNA","ZZZAETNA POS","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,6.88,4.68,456.36,3.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 45380","ZZZAETNA - ZZZAETNA PPO-EPO - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","ZZZAETNA","ZZZAETNA PPO-EPO","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,1362.18,420.34,2575,643.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 77065","ZZZAETNA - ZZZAETNA PPO-EPO - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","ZZZAETNA","ZZZAETNA PPO-EPO","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,397.81,102.59,752,188]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - 93452","ZZZAETNA - ZZZAETNA PPO-EPO - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","ZZZAETNA","ZZZAETNA PPO-EPO","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,3363.38,420.34,6358,1589.5]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - A9552","ZZZAETNA - ZZZAETNA PPO-EPO - A9552 - PR F18 FDG","ZZZAETNA","ZZZAETNA PPO-EPO","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - CPT - Q9967","ZZZAETNA - ZZZAETNA PPO-EPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZAETNA","ZZZAETNA PPO-EPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 73721","ZZZAETNA - ZZZAETNA STUDENT HEALTH - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,2678.86,254.07,4304.3999999999996,1266]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 84443","ZZZAETNA - ZZZAETNA STUDENT HEALTH - 84443 - CHG ASSAY THYROID STIM HORMONE","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,60.31,14.82,456.36,28.5]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - 99213","ZZZAETNA - ZZZAETNA STUDENT HEALTH - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,146.53,23.27,456.36,69.25]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - CPT - A9581","ZZZAETNA - ZZZAETNA STUDENT HEALTH - A9581 - PR GADOXETATE DISODIUM INJ","ZZZAETNA","ZZZAETNA STUDENT HEALTH","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,52.37,15.3,456.36,24.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 45385","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,1299.3,420.34,2929.62,760]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 77065","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,321.39999999999998,102.59,752,188]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 85027","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - 85027 - CHG COMPLETE CBC","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,9.0399999999999991,5.71,456.36,11.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - CPT - 99213","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,65.91,23.27,456.36,69.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 19120","ZZZCCA ONECARE - ZZZCCA ONECARE - 19120 - PR EXCISE BREAST CYST","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4493.84,420.34,6229.57,1049.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 72148","ZZZCCA ONECARE - ZZZCCA ONECARE - 72148 - CHG MRI, LUMBAR SPINE","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,288.89,254.07,3938.05,1158.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 80048","ZZZCCA ONECARE - ZZZCCA ONECARE - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,8.8800000000000008,7.46,456.36,41.75]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - 99204","ZZZCCA ONECARE - ZZZCCA ONECARE - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,155.85,23.27,705,176.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - CPT - Q9963","ZZZCCA ONECARE - ZZZCCA ONECARE - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","ZZZCCA ONECARE","ZZZCCA ONECARE","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 70553","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - 70553 - CHG MRI BRAIN COMBO","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,453.39,398.75,5879.45,1729.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 81003","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.36,1.63,456.36,4.25]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - 90715","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - 90715 - PR TDAP VACCINE >7 YO, IM","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - CPT - J1030","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 62323","ZZZCIGNA - CIGNA LOCALPLUS - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","ZZZCIGNA","CIGNA LOCALPLUS","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1262.25,420.34,1505.24,371.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 70553","ZZZCIGNA - CIGNA LOCALPLUS - 70553 - CHG MRI BRAIN COMBO","ZZZCIGNA","CIGNA LOCALPLUS","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,5879.45,398.75,5879.45,1729.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 85610","ZZZCIGNA - CIGNA LOCALPLUS - 85610 - CHG PROTHROMBIN TIME","ZZZCIGNA","CIGNA LOCALPLUS","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,4.34,3.58,456.36,7.25]
["ZZZCIGNA - CIGNA LOCALPLUS - CPT - 99214","ZZZCIGNA - CIGNA LOCALPLUS - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","ZZZCIGNA","CIGNA LOCALPLUS","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,358.7,23.27,456.36,105.5]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 43235","ZZZCIGNA - ZZZCIGNA CARELINK - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1505.24,420.34,1871.88,376.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 76700","ZZZCIGNA - ZZZCIGNA CARELINK - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,353.57,111.92,961.35,282.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 80053","ZZZCIGNA - ZZZCIGNA CARELINK - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,28.89,9.31,456.36,67.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - 99205","ZZZCIGNA - ZZZCIGNA CARELINK - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","ZZZCIGNA","ZZZCIGNA CARELINK","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,27.28,23.27,899,224.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - P9047","ZZZCIGNA - ZZZCIGNA CARELINK - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","ZZZCIGNA","ZZZCIGNA CARELINK","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,57.24,50.13,456.36,45]
["ZZZCIGNA - ZZZCIGNA CARELINK - CPT - Q9967","ZZZCIGNA - ZZZCIGNA CARELINK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZCIGNA","ZZZCIGNA CARELINK","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 70553","ZZZCIGNA - ZZZCIGNA STANDARD - 70553 - CHG MRI BRAIN COMBO","ZZZCIGNA","ZZZCIGNA STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,5879.45,398.75,5879.45,1729.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - 90846","ZZZCIGNA - ZZZCIGNA STANDARD - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","ZZZCIGNA","ZZZCIGNA STANDARD","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,261.8,30.9,456.36,77]
["ZZZCIGNA - ZZZCIGNA STANDARD - CPT - A9552","ZZZCIGNA - ZZZCIGNA STANDARD - A9552 - PR F18 FDG","ZZZCIGNA","ZZZCIGNA STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,862.75,365.4,1015,253.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 43239","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,731.71,420.34,1871.88,428]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 62322","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,609.47,82.95,1426,356.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 76830","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,131.47999999999999,113.99,873.8,257]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99204","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,150.71,23.27,705,176.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - 99215","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,132.82,23.27,595,148.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - CPT - Q9967","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,0.52333333333333332,0.12,456.36,0.30555555555555558]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 72110","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,123.44,46.45,595,148.75]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - 90847","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,179.02,30.9,456.36,90.75]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - CPT - A9579","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 43239","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1871.88,420.34,1871.88,428]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 73721","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,451.66,254.07,4304.3999999999996,1266]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 84443","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - 84443 - CHG ASSAY THYROID STIM HORMONE","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,51,14.82,456.36,28.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - 90715","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - 90715 - PR TDAP VACCINE >7 YO, IM","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - CPT - Q9967","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 45385","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 81000","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,9.8800000000000008,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 95810","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2243.64,420.34,3344.75,983.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - 99204","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - CPT - Q9967","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 74177","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,755.93,398.75,2773.55,815.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 77067","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,488,108.47,488,122]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - 90837","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,108.15,27.84,456.36,53.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - CPT - J1030","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 66984","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,4241.13,420.34,4241.13,556]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 81000","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,9.8800000000000008,2.89,456.36,6]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 85730","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,16.39,5.3,456.36,10.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - CPT - 99213","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 29881","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 55700","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2286.9499999999998,420.34,3848.68,587]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 80053","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,10.56,9.31,456.36,67.75]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - 99203","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,148.41999999999999,23.27,456.36,103.75]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - CPT - Q9958","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 43235","ZZZUNITED - ZZZUNITED DEFINITY HRA - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1505,420.34,1871.88,376.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 76830","ZZZUNITED - ZZZUNITED DEFINITY HRA - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,272.94,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - 85730","ZZZUNITED - ZZZUNITED DEFINITY HRA - 85730 - CHG THROMBOPLAS TIME PARTIAL","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.41,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - A9579","ZZZUNITED - ZZZUNITED DEFINITY HRA - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - CPT - Q9967","ZZZUNITED - ZZZUNITED DEFINITY HRA - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED DEFINITY HRA","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 66821","ZZZUNITED - ZZZUNITED HP SHIP - 66821 - PR DISCISSION,2ND CATARACT,LASER","ZZZUNITED","ZZZUNITED HP SHIP","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1219.6099999999999,420.34,2389.35,702.75]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 84443","ZZZUNITED - ZZZUNITED HP SHIP - 84443 - CHG ASSAY THYROID STIM HORMONE","ZZZUNITED","ZZZUNITED HP SHIP","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,51,14.82,456.36,28.5]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - 99212","ZZZUNITED - ZZZUNITED HP SHIP - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","ZZZUNITED","ZZZUNITED HP SHIP","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED HP SHIP - CPT - Q9963","ZZZUNITED - ZZZUNITED HP SHIP - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED HP SHIP","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 45385","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2408.3200000000002,420.34,2929.62,760]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 77066","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,924,131.5,924,231]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 85610","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 85610 - CHG PROTHROMBIN TIME","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99212","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99213","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99213","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99214","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,422,23.27,456.36,105.5]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99214","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,422,23.27,456.36,105.5]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99215","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - CPT - 99215","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75]
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["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 62322","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,1426,82.95,1426,356.5]
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["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 64483","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1879.97,420.34,1879.97,386.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 66821","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 66821 - PR DISCISSION,2ND CATARACT,LASER","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1219.6099999999999,420.34,2389.35,702.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 66984","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,4241.13,420.34,4241.13,556]
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["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 70553","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 70553 - CHG MRI BRAIN COMBO","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,755.93,398.75,5879.45,1729.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 70553","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 70553 - CHG MRI BRAIN COMBO","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,755.93,398.75,5879.45,1729.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 72110","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,595,46.45,595,148.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 72148","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 72148 - CHG MRI, LUMBAR SPINE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,451.66,254.07,3938.05,1158.25]
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["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 73721","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,451.66,254.07,4304.3999999999996,1266]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 74177","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,755.93,398.75,2773.55,815.75]
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["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76700","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,220.4,111.92,961.35,282.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76805","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76805","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,220.4,113.99,1013.2,298]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76830","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,220.4,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 76830","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,220.4,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 77065","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,752,102.59,752,188]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 77066","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,924,131.5,924,231]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 77067","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,488,108.47,488,122]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80048","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,25.66,7.46,456.36,41.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80053","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,32.049999999999997,9.31,456.36,67.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80055","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 80055 - CHG OBSTETRIC PANEL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,130.57,18.32,456.36,65]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80061","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 80061 - CHG LIPID PANEL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,40.630000000000003,11.81,456.36,32.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80069","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 80069 - CHG RENAL FUNCTION PANEL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,26.35,7.66,456.36,48.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 80076","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 80076 - CHG HEPATIC FUNCTION PANEL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,22.32,7.21,456.36,40.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81000","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,9.8800000000000008,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81000","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,9.8800000000000008,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81001","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,8.65,2.8,456.36,6]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81002","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.5500000000000007,2.34,456.36,4.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81002","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,8.5500000000000007,2.34,456.36,4.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81003","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,6.81,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 81003","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,6.81,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 84153","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,50.24,13.26,456.36,31.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 84443","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 84443 - CHG ASSAY THYROID STIM HORMONE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,51,14.82,456.36,28.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85025","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,21.21,6.85,456.36,13.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85027","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 85027 - CHG COMPLETE CBC","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,17.649999999999999,5.71,456.36,11.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85610","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 85610 - CHG PROTHROMBIN TIME","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85610","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 85610 - CHG PROTHROMBIN TIME","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,11.92,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85730","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 85730 - CHG THROMBOPLAS TIME PARTIAL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,16.39,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 85730","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 85730 - CHG THROMBOPLAS TIME PARTIAL","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,16.39,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90662","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,73.400000000000006,36.119999999999997,456.36,32.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90686","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,22.35,19.16,456.36,18.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90715","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90715 - PR TDAP VACCINE >7 YO, IM","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90832","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,84.5,21.97,456.36,42]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90834","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,108.15,27.84,456.36,53.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90837","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,108.15,27.84,456.36,53.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90846","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,154.91999999999999,30.9,456.36,77]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90847","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,182.59,30.9,456.36,90.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 90853","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 90853 - PR GROUP PSYCHOTHERAPY","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,64.89,15.63,456.36,32.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 93452","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,6358,420.34,6358,1589.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 95810","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2243.64,420.34,3344.75,983.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 97110","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 97110 - PR THERAPEUTIC EXERCISES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,145.28,23.1,456.36,62.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99203","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,415,23.27,456.36,103.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99203","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,415,23.27,456.36,103.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99204","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99204","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,705,23.27,705,176.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99205","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99205","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,899,23.27,899,224.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99212","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99212","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99213","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99213","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99214","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,422,23.27,456.36,105.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99214","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,422,23.27,456.36,105.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99215","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99215","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,595,23.27,595,148.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99385","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99385 - PR PREVENTIVE VISIT,NEW,18-39","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99385,"PR PREVENTIVE VISIT,NEW,18-39","99385 - PR PREVENTIVE VISIT,NEW,18-39",530,266.58999999999997,23.27,530,132.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - 99386","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - 99386 - PR PREVENTIVE VISIT,NEW,40-64","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT",99386,"PR PREVENTIVE VISIT,NEW,40-64","99386 - PR PREVENTIVE VISIT,NEW,40-64",640,321.92,23.27,640,160]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9500","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9500 - PR TC99M SESTAMIBI","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9513","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9513 - DELETED 2077","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,285.07,154.44,456.36,107.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9517","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9517 - PR I131 IODIDE CAP, RX","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,36.409999999999997,20.12,456.36,130.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9552","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9552 - PR F18 FDG","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9555","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9555 - PR RB82 RUBIDIUM","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9575","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9579","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9579","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - A9581","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - A9581 - PR GADOXETATE DISODIUM INJ","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - J1030","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - J3301","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - P9047","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,52.45,50.13,456.36,45]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9958","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
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["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - CPT - Q9967","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 19120","ZZZUNITED - ZZZUNITED STANDARD - 19120 - PR EXCISE BREAST CYST","ZZZUNITED","ZZZUNITED STANDARD","CPT",19120,"PR EXCISE BREAST CYST","19120 - PR EXCISE BREAST CYST",4199,4199,420.34,6229.57,1049.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 29881","ZZZUNITED - ZZZUNITED STANDARD - 29881 - PR KNEE SCOPE SINGLE MENISCECTOMY","ZZZUNITED","ZZZUNITED STANDARD","CPT",29881,"PR KNEE SCOPE SINGLE MENISCECTOMY","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY",5454,597.14,420.34,5454,1363.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 43235","ZZZUNITED - ZZZUNITED STANDARD - 43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","ZZZUNITED","ZZZUNITED STANDARD","CPT",43235,"PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC",1505,1505,420.34,1871.88,376.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 43239","ZZZUNITED - ZZZUNITED STANDARD - 43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","ZZZUNITED","ZZZUNITED STANDARD","CPT",43239,"PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE",1712,1712,420.34,1871.88,428]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45378","ZZZUNITED - ZZZUNITED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","ZZZUNITED","ZZZUNITED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,2154,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45378","ZZZUNITED - ZZZUNITED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","ZZZUNITED","ZZZUNITED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,2154,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45378","ZZZUNITED - ZZZUNITED STANDARD - 45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","ZZZUNITED","ZZZUNITED STANDARD","CPT",45378,"PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD",2154,2154,395.43,2154,538.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45380","ZZZUNITED - ZZZUNITED STANDARD - 45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","ZZZUNITED","ZZZUNITED STANDARD","CPT",45380,"PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE",2575,2575,420.34,2575,643.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45385","ZZZUNITED - ZZZUNITED STANDARD - 45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","ZZZUNITED","ZZZUNITED STANDARD","CPT",45385,"PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",3040,2929.62,420.34,2929.62,760]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 45391","ZZZUNITED - ZZZUNITED STANDARD - 45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","ZZZUNITED","ZZZUNITED STANDARD","CPT",45391,"PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX",2924,2924,420.34,2924,731]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 55700","ZZZUNITED - ZZZUNITED STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","ZZZUNITED","ZZZUNITED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2348,420.34,3848.68,587]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 55700","ZZZUNITED - ZZZUNITED STANDARD - 55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","ZZZUNITED","ZZZUNITED STANDARD","CPT",55700,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",2348,2348,420.34,3848.68,587]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 62322","ZZZUNITED - ZZZUNITED STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","ZZZUNITED","ZZZUNITED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 62322","ZZZUNITED - ZZZUNITED STANDARD - 62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","ZZZUNITED","ZZZUNITED STANDARD","CPT",62322,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN",1426,82.95,82.95,1426,356.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 62323","ZZZUNITED - ZZZUNITED STANDARD - 62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","ZZZUNITED","ZZZUNITED STANDARD","CPT",62323,"PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN",1485,1485,420.34,1505.24,371.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 64483","ZZZUNITED - ZZZUNITED STANDARD - 64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","ZZZUNITED","ZZZUNITED STANDARD","CPT",64483,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",1545,1545,420.34,1879.97,386.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 66821","ZZZUNITED - ZZZUNITED STANDARD - 66821 - PR DISCISSION,2ND CATARACT,LASER","ZZZUNITED","ZZZUNITED STANDARD","CPT",66821,"PR DISCISSION,2ND CATARACT,LASER","66821 - PR DISCISSION,2ND CATARACT,LASER",2811,1443.05,420.34,2389.35,702.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 66984","ZZZUNITED - ZZZUNITED STANDARD - 66984 - PR REMV CATARACT EXTRACAP,INSERT LENS","ZZZUNITED","ZZZUNITED STANDARD","CPT",66984,"PR REMV CATARACT EXTRACAP,INSERT LENS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS",2224,2224,420.34,4241.13,556]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 70450","ZZZUNITED - ZZZUNITED STANDARD - 70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","ZZZUNITED","ZZZUNITED STANDARD","CPT",70450,"CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",2022,272.94,113.99,1718.7,505.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 70553","ZZZUNITED - ZZZUNITED STANDARD - 70553 - CHG MRI BRAIN COMBO","ZZZUNITED","ZZZUNITED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,954.74,398.75,5879.45,1729.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 70553","ZZZUNITED - ZZZUNITED STANDARD - 70553 - CHG MRI BRAIN COMBO","ZZZUNITED","ZZZUNITED STANDARD","CPT",70553,"CHG MRI BRAIN COMBO","70553 - CHG MRI BRAIN COMBO",6917,954.74,398.75,5879.45,1729.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 72110","ZZZUNITED - ZZZUNITED STANDARD - 72110 - CHG X-RAY LUMBAR SPINE 4 VW","ZZZUNITED","ZZZUNITED STANDARD","CPT",72110,"CHG X-RAY LUMBAR SPINE 4 VW","72110 - CHG X-RAY LUMBAR SPINE 4 VW",595,272.94,46.45,595,148.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 72148","ZZZUNITED - ZZZUNITED STANDARD - 72148 - CHG MRI, LUMBAR SPINE","ZZZUNITED","ZZZUNITED STANDARD","CPT",72148,"CHG MRI, LUMBAR SPINE","72148 - CHG MRI, LUMBAR SPINE",4633,608.33000000000004,254.07,3938.05,1158.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 72193","ZZZUNITED - ZZZUNITED STANDARD - 72193 - CHG CT SCAN OF PELVIS CONTRAST","ZZZUNITED","ZZZUNITED STANDARD","CPT",72193,"CHG CT SCAN OF PELVIS CONTRAST","72193 - CHG CT SCAN OF PELVIS CONTRAST",3040,456.13,190.5,2584,760]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 73721","ZZZUNITED - ZZZUNITED STANDARD - 73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST","ZZZUNITED","ZZZUNITED STANDARD","CPT",73721,"CHG MRI LOWER EXTREM JT, W/O CONTRAST","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST",5064,608.33000000000004,254.07,4304.3999999999996,1266]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 74177","ZZZUNITED - ZZZUNITED STANDARD - 74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","ZZZUNITED","ZZZUNITED STANDARD","CPT",74177,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",3263,954.74,398.75,2773.55,815.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76700","ZZZUNITED - ZZZUNITED STANDARD - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","ZZZUNITED","ZZZUNITED STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,272.94,111.92,961.35,282.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76700","ZZZUNITED - ZZZUNITED STANDARD - 76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","ZZZUNITED","ZZZUNITED STANDARD","CPT",76700,"CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",1131,272.94,111.92,961.35,282.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76805","ZZZUNITED - ZZZUNITED STANDARD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","ZZZUNITED","ZZZUNITED STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,272.94,113.99,1013.2,298]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76805","ZZZUNITED - ZZZUNITED STANDARD - 76805 - CHG US, OB >/= 14 WKS, SNGL FETUS","ZZZUNITED","ZZZUNITED STANDARD","CPT",76805,"CHG US, OB >/= 14 WKS, SNGL FETUS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS",1192,272.94,113.99,1013.2,298]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76830","ZZZUNITED - ZZZUNITED STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZUNITED","ZZZUNITED STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,272.94,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 76830","ZZZUNITED - ZZZUNITED STANDARD - 76830 - CHG ECHOGRAPHY,TRANSVAGINAL","ZZZUNITED","ZZZUNITED STANDARD","CPT",76830,"CHG ECHOGRAPHY,TRANSVAGINAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL",1028,272.94,113.99,873.8,257]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 77065","ZZZUNITED - ZZZUNITED STANDARD - 77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","ZZZUNITED","ZZZUNITED STANDARD","CPT",77065,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI",752,153.79,102.59,752,188]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 77066","ZZZUNITED - ZZZUNITED STANDARD - 77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","ZZZUNITED","ZZZUNITED STANDARD","CPT",77066,"CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI",924,196.42,131.5,924,231]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 77067","ZZZUNITED - ZZZUNITED STANDARD - 77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","ZZZUNITED","ZZZUNITED STANDARD","CPT",77067,"CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",488,162.43,108.47,488,122]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80048","ZZZUNITED - ZZZUNITED STANDARD - 80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL","ZZZUNITED","ZZZUNITED STANDARD","CPT",80048,"CHG BASIC METABOLIC PANEL CALCIUM TOTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL",167,7.61,7.46,456.36,41.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80053","ZZZUNITED - ZZZUNITED STANDARD - 80053 - CHG METABOLIC PANEL,COMPREHENSIVE","ZZZUNITED","ZZZUNITED STANDARD","CPT",80053,"CHG METABOLIC PANEL,COMPREHENSIVE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE",271,9.5,9.31,456.36,67.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80055","ZZZUNITED - ZZZUNITED STANDARD - 80055 - CHG OBSTETRIC PANEL","ZZZUNITED","ZZZUNITED STANDARD","CPT",80055,"CHG OBSTETRIC PANEL","80055 - CHG OBSTETRIC PANEL",260,43.03,18.32,456.36,65]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80061","ZZZUNITED - ZZZUNITED STANDARD - 80061 - CHG LIPID PANEL","ZZZUNITED","ZZZUNITED STANDARD","CPT",80061,"CHG LIPID PANEL","80061 - CHG LIPID PANEL",129,12.05,11.81,456.36,32.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80069","ZZZUNITED - ZZZUNITED STANDARD - 80069 - CHG RENAL FUNCTION PANEL","ZZZUNITED","ZZZUNITED STANDARD","CPT",80069,"CHG RENAL FUNCTION PANEL","80069 - CHG RENAL FUNCTION PANEL",195,7.81,7.66,456.36,48.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 80076","ZZZUNITED - ZZZUNITED STANDARD - 80076 - CHG HEPATIC FUNCTION PANEL","ZZZUNITED","ZZZUNITED STANDARD","CPT",80076,"CHG HEPATIC FUNCTION PANEL","80076 - CHG HEPATIC FUNCTION PANEL",163,7.35,7.21,456.36,40.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81000","ZZZUNITED - ZZZUNITED STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","ZZZUNITED","ZZZUNITED STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.62,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81000","ZZZUNITED - ZZZUNITED STANDARD - 81000 - CHG URINALYSIS, NONAUTO, W/SCOPE","ZZZUNITED","ZZZUNITED STANDARD","CPT",81000,"CHG URINALYSIS, NONAUTO, W/SCOPE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE",24,3.62,2.89,456.36,6]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81001","ZZZUNITED - ZZZUNITED STANDARD - 81001 - CHG URINALYSIS, AUTO, W/SCOPE","ZZZUNITED","ZZZUNITED STANDARD","CPT",81001,"CHG URINALYSIS, AUTO, W/SCOPE","81001 - CHG URINALYSIS, AUTO, W/SCOPE",24,2.85,2.8,456.36,6]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81002","ZZZUNITED - ZZZUNITED STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","ZZZUNITED","ZZZUNITED STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.13,2.34,456.36,4.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81002","ZZZUNITED - ZZZUNITED STANDARD - 81002 - CHG URINALYSIS NONAUTO W/O SCOPE","ZZZUNITED","ZZZUNITED STANDARD","CPT",81002,"CHG URINALYSIS NONAUTO W/O SCOPE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE",17,3.13,2.34,456.36,4.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81003","ZZZUNITED - ZZZUNITED STANDARD - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","ZZZUNITED","ZZZUNITED STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.0299999999999998,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 81003","ZZZUNITED - ZZZUNITED STANDARD - 81003 - CHG URINALYSIS, AUTO, W/O SCOPE","ZZZUNITED","ZZZUNITED STANDARD","CPT",81003,"CHG URINALYSIS, AUTO, W/O SCOPE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE",17,2.0299999999999998,1.63,456.36,4.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 84153","ZZZUNITED - ZZZUNITED STANDARD - 84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","ZZZUNITED","ZZZUNITED STANDARD","CPT",84153,"CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL",125,16.55,13.26,456.36,31.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 84443","ZZZUNITED - ZZZUNITED STANDARD - 84443 - CHG ASSAY THYROID STIM HORMONE","ZZZUNITED","ZZZUNITED STANDARD","CPT",84443,"CHG ASSAY THYROID STIM HORMONE","84443 - CHG ASSAY THYROID STIM HORMONE",114,15.12,14.82,456.36,28.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85025","ZZZUNITED - ZZZUNITED STANDARD - 85025 - CHG COMPLETE CBC & AUTO DIFF WBC","ZZZUNITED","ZZZUNITED STANDARD","CPT",85025,"CHG COMPLETE CBC & AUTO DIFF WBC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC",55,6.99,6.85,456.36,13.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85027","ZZZUNITED - ZZZUNITED STANDARD - 85027 - CHG COMPLETE CBC","ZZZUNITED","ZZZUNITED STANDARD","CPT",85027,"CHG COMPLETE CBC","85027 - CHG COMPLETE CBC",45,5.82,5.71,456.36,11.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85610","ZZZUNITED - ZZZUNITED STANDARD - 85610 - CHG PROTHROMBIN TIME","ZZZUNITED","ZZZUNITED STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.86,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85610","ZZZUNITED - ZZZUNITED STANDARD - 85610 - CHG PROTHROMBIN TIME","ZZZUNITED","ZZZUNITED STANDARD","CPT",85610,"CHG PROTHROMBIN TIME","85610 - CHG PROTHROMBIN TIME",29,3.86,3.58,456.36,7.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85730","ZZZUNITED - ZZZUNITED STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","ZZZUNITED","ZZZUNITED STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.41,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 85730","ZZZUNITED - ZZZUNITED STANDARD - 85730 - CHG THROMBOPLAS TIME PARTIAL","ZZZUNITED","ZZZUNITED STANDARD","CPT",85730,"CHG THROMBOPLAS TIME PARTIAL","85730 - CHG THROMBOPLAS TIME PARTIAL",42,5.41,5.3,456.36,10.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90662","ZZZUNITED - ZZZUNITED STANDARD - 90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","ZZZUNITED","ZZZUNITED STANDARD","CPT",90662,"PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE",129,57.77,36.119999999999997,456.36,32.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90686","ZZZUNITED - ZZZUNITED STANDARD - 90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","ZZZUNITED","ZZZUNITED STANDARD","CPT",90686,"PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE",74,19.16,19.16,456.36,18.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90715","ZZZUNITED - ZZZUNITED STANDARD - 90715 - PR TDAP VACCINE >7 YO, IM","ZZZUNITED","ZZZUNITED STANDARD","CPT",90715,"PR TDAP VACCINE >7 YO, IM","90715 - PR TDAP VACCINE >7 YO, IM",180,180,39.75,456.36,45]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90832","ZZZUNITED - ZZZUNITED STANDARD - 90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",90832,"PR PSYCHOTHERAPY W/PATIENT 30 MINUTES","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES",168,168,21.97,456.36,42]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90834","ZZZUNITED - ZZZUNITED STANDARD - 90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",90834,"PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",215,215,27.84,456.36,53.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90837","ZZZUNITED - ZZZUNITED STANDARD - 90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",90837,"PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",215,215,27.84,456.36,53.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90846","ZZZUNITED - ZZZUNITED STANDARD - 90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","ZZZUNITED","ZZZUNITED STANDARD","CPT",90846,"PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS",308,308,30.9,456.36,77]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90847","ZZZUNITED - ZZZUNITED STANDARD - 90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","ZZZUNITED","ZZZUNITED STANDARD","CPT",90847,"PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS",363,363,30.9,456.36,90.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 90853","ZZZUNITED - ZZZUNITED STANDARD - 90853 - PR GROUP PSYCHOTHERAPY","ZZZUNITED","ZZZUNITED STANDARD","CPT",90853,"PR GROUP PSYCHOTHERAPY","90853 - PR GROUP PSYCHOTHERAPY",129,129,15.63,456.36,32.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 93452","ZZZUNITED - ZZZUNITED STANDARD - 93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","ZZZUNITED","ZZZUNITED STANDARD","CPT",93452,"PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I",6358,768.9,420.34,6358,1589.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 95810","ZZZUNITED - ZZZUNITED STANDARD - 95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","ZZZUNITED","ZZZUNITED STANDARD","CPT",95810,"PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND",3935,2595.64,420.34,3344.75,983.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 97110","ZZZUNITED - ZZZUNITED STANDARD - 97110 - PR THERAPEUTIC EXERCISES","ZZZUNITED","ZZZUNITED STANDARD","CPT",97110,"PR THERAPEUTIC EXERCISES","97110 - PR THERAPEUTIC EXERCISES",249,32.11,23.1,456.36,62.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99203","ZZZUNITED - ZZZUNITED STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,328.17,23.27,456.36,103.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99203","ZZZUNITED - ZZZUNITED STANDARD - 99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99203,"PR OFFICE OUTPATIENT NEW 30-44 MINUTES","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES",415,328.17,23.27,456.36,103.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99204","ZZZUNITED - ZZZUNITED STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,328.17,23.27,705,176.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99204","ZZZUNITED - ZZZUNITED STANDARD - 99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99204,"PR OFFICE OUTPATIENT NEW 45-59 MINUTES","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES",705,328.17,23.27,705,176.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99205","ZZZUNITED - ZZZUNITED STANDARD - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,328.17,23.27,899,224.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99205","ZZZUNITED - ZZZUNITED STANDARD - 99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99205,"PR OFFICE OUTPATIENT NEW 60-74 MINUTES","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES",899,328.17,23.27,899,224.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99212","ZZZUNITED - ZZZUNITED STANDARD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99212","ZZZUNITED - ZZZUNITED STANDARD - 99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99212,"PR OFFICE OUTPATIENT VISIT 10-19 MINUTES","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES",147,147,23.27,456.36,36.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99213","ZZZUNITED - ZZZUNITED STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99213","ZZZUNITED - ZZZUNITED STANDARD - 99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99213,"PR OFFICE OUTPATIENT VISIT 20-29 MINUTES","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES",277,277,23.27,456.36,69.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99214","ZZZUNITED - ZZZUNITED STANDARD - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,328.17,23.27,456.36,105.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99214","ZZZUNITED - ZZZUNITED STANDARD - 99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99214,"PR OFFICE OUTPATIENT VISIT 30-39 MINUTES","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES",422,328.17,23.27,456.36,105.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99215","ZZZUNITED - ZZZUNITED STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,328.17,23.27,595,148.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - 99215","ZZZUNITED - ZZZUNITED STANDARD - 99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","ZZZUNITED","ZZZUNITED STANDARD","CPT",99215,"PR OFFICE OUTPATIENT VISIT 40-54 MINUTES","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES",595,328.17,23.27,595,148.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9500","ZZZUNITED - ZZZUNITED STANDARD - A9500 - PR TC99M SESTAMIBI","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9500","PR TC99M SESTAMIBI","A9500 - PR TC99M SESTAMIBI",357,357,128.52000000000001,456.36,89.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9513","ZZZUNITED - ZZZUNITED STANDARD - A9513 - DELETED 2077","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9513","DELETED 2077","A9513 - DELETED 2077",429,429,154.44,456.36,107.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9517","ZZZUNITED - ZZZUNITED STANDARD - A9517 - PR I131 IODIDE CAP, RX","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9517","PR I131 IODIDE CAP, RX","A9517 - PR I131 IODIDE CAP, RX",523,55.6,20.12,456.36,130.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9552","ZZZUNITED - ZZZUNITED STANDARD - A9552 - PR F18 FDG","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9552","PR F18 FDG","A9552 - PR F18 FDG",1015,1015,365.4,1015,253.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9555","ZZZUNITED - ZZZUNITED STANDARD - A9555 - PR RB82 RUBIDIUM","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9555","PR RB82 RUBIDIUM","A9555 - PR RB82 RUBIDIUM",1385,1385,420.34,1385,346.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9575","ZZZUNITED - ZZZUNITED STANDARD - A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9575","PR INJ GADOTERATE MEGLUMI 0.1ML","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML",8,8,0.13,456.36,2]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9579","ZZZUNITED - ZZZUNITED STANDARD - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9579","ZZZUNITED - ZZZUNITED STANDARD - A9579 - GAD-BASE MR CONTRAST NOS,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9579","GAD-BASE MR CONTRAST NOS,1ML","A9579 - GAD-BASE MR CONTRAST NOS,1ML",4,4,1.08,456.36,1]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - A9581","ZZZUNITED - ZZZUNITED STANDARD - A9581 - PR GADOXETATE DISODIUM INJ","ZZZUNITED","ZZZUNITED STANDARD","CPT","A9581","PR GADOXETATE DISODIUM INJ","A9581 - PR GADOXETATE DISODIUM INJ",99,99,15.3,456.36,24.75]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - J1030","ZZZUNITED - ZZZUNITED STANDARD - J1030 - PR METHYLPREDNISOLONE 40 MG INJ","ZZZUNITED","ZZZUNITED STANDARD","CPT","J1030","PR METHYLPREDNISOLONE 40 MG INJ","J1030 - PR METHYLPREDNISOLONE 40 MG INJ",13,13,4.68,456.36,3.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - J3301","ZZZUNITED - ZZZUNITED STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","ZZZUNITED","ZZZUNITED STANDARD","CPT","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",18,18,0.98,456.36,4.5]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - P9047","ZZZUNITED - ZZZUNITED STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",180,138.30000000000001,50.13,456.36,45]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9958","ZZZUNITED - ZZZUNITED STANDARD - Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9958","PR HOCM <=149 MG/ML IODINE, 1ML","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML",1,1,0.09,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9963","ZZZUNITED - ZZZUNITED STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9963","ZZZUNITED - ZZZUNITED STANDARD - Q9963 - PR HOCM 350-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9963","PR HOCM 350-399MG/ML IODINE,1ML","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML",1,1,0.22,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9966","ZZZUNITED - ZZZUNITED STANDARD - Q9966 - LOCM 200-299MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9966","LOCM 200-299MG/ML IODINE,1ML","Q9966 - LOCM 200-299MG/ML IODINE,1ML",1,1,0.36,456.36,0.25]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]
["ZZZUNITED - ZZZUNITED STANDARD - CPT - Q9967","ZZZUNITED - ZZZUNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED STANDARD","CPT","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1.2222222222222223,1.2222222222222223,0.12,456.36,0.30555555555555558]

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["CORRECTIONS","CORRECTIONS PLYMOUTH CORR"]
["CORRECTIONS","CORRECTIONS SUFFOLK COUNTY"]
["CORRECTIONS","ZZZCORRECTIONS BAY STATE"]
["CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL"]
["CORRECTIONS","ZZZCORRECTIONS BRADSTON"]
["CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST"]
["CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED"]
["CORRECTIONS","ZZZCORRECTIONS CEDAR"]
["CORRECTIONS","ZZZCORRECTIONS CONCORD"]
["CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON"]
["CORRECTIONS","ZZZCORRECTIONS GARDNER"]
["CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK"]
["CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL"]
["CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB"]
["CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR"]
["CORRECTIONS","ZZZCORRECTIONS NASHUA"]
["CORRECTIONS","ZZZCORRECTIONS NORFOLK"]
["CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR"]
["CORRECTIONS","ZZZCORRECTIONS OLD COLONY"]
["CORRECTIONS","ZZZCORRECTIONS PLYMOUTH"]
["CORRECTIONS","ZZZCORRECTIONS PONDVILLE"]
["CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR"]
["CORRECTIONS","ZZZCORRECTIONS SHIRLEY"]
["CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI"]
["CORRECTIONS","ZZZORRECTIONS FRAMINGHAM"]
["FALLON","FALLON COMMUNITY PLAN"]
["FALLON","FALLON HMO STANDARD"]
["FALLON","FALLON POS STANDARD"]
["FALLON","FALLON PPO STANDARD"]
["FALLON HEALTHCRE ACO","FALLON HEALTHCARE ACO ATRIUS"]
["FALLON HEALTHCRE ACO","FALLON HEALTHCRE ACO BRKSHRE"]
["FALLON HEALTHCRE ACO","FALLON HEALTHCRE ACO RELIANT"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 CARE PLUS"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 COMMONHLTH"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 STANDARD"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE CAREPLUS"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WELLFORCE"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE CAREPLUS"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE COMMHLTH"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE STANDARD"]
["FALLON MEDICAID MANAGED","FALLON MCD MNG CARE PLUS"]
["FALLON MEDICAID MANAGED","FALLON MCD MNG STANDARD"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG POS"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG PPO"]
["FALLON MEDICARE MANAGED","FALLON MCR MNG HMO"]
["FALLON SCO","FALLON SCO HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC PPO"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO"]
["HEALTH PLANS INC","HEALTH PLANS INC STANDARD"]
["HLTH NEW ENGLAND ACO","HLTH NEW ENGLAND ACO BE HEALTHY"]
["HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE"]
["HSN","HSN STANDARD"]
["HSN","HSN TEMPORARY"]
["HSN BAD DEBT","HSN BAD DEBT"]
["HSN CONFIDENTIAL","HSN CONFIDENTIAL"]
["HSN DENTAL","HSN DENTAL"]
["HSN PARTIAL","HSN PARTIAL STANDARD"]
["HSN PARTIAL","HSN PARTIAL TEMPORARY"]
["HUMANA MEDICARE","HUMANA MEDICARE STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","MASS GEN BRIG HLTH PLAN ACO MYCARE FAM"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","MASS GENERAL BRIG HLTH PLAN ACO STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG COMMON"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGH HLTHPLAN MCD MNG CMA"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG CARE"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM MCD MNG STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE HMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 2"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO"]
["MEDICAID","CMSP STANDARD"]
["MEDICAID","MEDICAID CARE PLUS"]
["MEDICAID","MEDICAID COMMONHEALTH"]
["MEDICAID","MEDICAID CORRECTIONS IP"]
["MEDICAID","MEDICAID EAEDC"]
["MEDICAID","MEDICAID FAMILY ASSIST"]
["MEDICAID","MEDICAID SENIOR BUY-IN"]
["MEDICAID","MEDICAID STANDARD"]
["MEDICAID ACO","MEDICAID ACO COMM"]
["MEDICAID ACO","MEDICAID ACO MASS GENERAL BRIG"]
["MEDICAID ACO","MEDICAID ACO STEWRD"]
["MEDICAID ACO","MEDICAID ACO STEWRD FAM ASSIS"]
["MEDICAID ACO","ZZZMEDICAID ACO COMM CARE PLUS"]
["MEDICAID ACO","ZZZMEDICAID ACO COMM COMMONHLTH"]
["MEDICAID ACO","ZZZMEDICAID ACO COMM FAM ASSIST"]
["MEDICAID ACO","ZZZMEDICAID ACO COMM STANDARD"]
["MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS"]
["MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG COMMONHLT"]
["MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG FAM ASSIS"]
["MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD"]
["MEDICAID ACO","ZZZMEDICAID ACO STEWRD CARE PLUS"]
["MEDICAID ACO","ZZZMEDICAID ACO STEWRD COMMONHLT"]
["MEDICAID ACO","ZZZMEDICAID ACO STEWRD FAM ASSIS"]
["MEDICAID ACO","ZZZMEDICAID ACO STEWRD STANDARD"]
["MEDICAID LIMITED","MEDICAID LIMITED LIMITED"]
["MEDICAID MANAGED CARE","MCD MNG CARE CARE PLUS"]
["MEDICAID MANAGED CARE","MCD MNG CARE COMMONHEALTH"]
["MEDICAID MANAGED CARE","MCD MNG CARE ESSENTIAL"]
["MEDICAID MANAGED CARE","MCD MNG CARE FAMILY ASSIST"]
["MEDICAID MANAGED CARE","MCD MNG CARE STANDARD"]
["MEDICARE","MEDICARE A&B"]
["MEDICARE","MEDICARE PART A ONLY"]
["MEDICARE","MEDICARE PART B ONLY"]
["MEDICARE","RAILROAD MEDICARE  RAILROAD"]
["NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD"]
["OXFORD HEALTH","OXFORD HEALTH STANDARD"]
["OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD"]
["SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD"]
["TRICARE EAST","TRICARE EAST PRIME (HMO)"]
["TRICARE EAST","TRICARE EAST SELECT"]
["TRICARE FOR LIFE","TRICARE FOR LIFE"]
["TUFTS","TUFTS CARELINK"]
["TUFTS","TUFTS HMO"]
["TUFTS","TUFTS POS"]
["TUFTS","TUFTS PPO"]
["TUFTS","TUFTS SELECT"]
["TUFTS","TUFTS SPIRIT"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED"]
["TUFTS MEDICARE","TUFTS MEDICARE HMO"]
["TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS"]
["TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS"]
["TUFTS TOGETHER ACO","TUFTS TOGETHER ACO CHA"]
["TUFTS TOGETHER ACO","TUFTS TOGETHER ACO UMASS MEMORIAL"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS STANDARD"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH COMMONHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH FAM ASSIST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH STANDARD"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO COMMONHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO STANDARD"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA COMMONHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA FAM ASSIST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA STANDARD"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY COMMONHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY STANDARD"]
["TUFTS TOGETHER MCO","TUFTS TOGETHER MCO"]
["TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO CARE PLUS"]
["TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO FAMILY ASSIST"]
["TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO STANDARD"]
["UBH HPHC","UBH HPHC"]
["UNICARE","UNICARE STANDARD"]
["UNITED","UNITED DEFINITY HRA"]
["UNITED","UNITED HP SHIP"]
["UNITED","UNITED HP STUDENT HEALTH"]
["UNITED","UNITED NAVIGATE"]
["UNITED","UNITED PASSPORT CONNECT"]
["UNITED","UNITED STANDARD"]
["UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO"]
["UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD"]
["UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG HMO"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG PPO"]
["UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO"]
["UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO"]
["UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD"]
["WELLCARE","WELLCARE HMO"]
["WELLCARE","WELLCARE PPO"]
["WELLCARE","WELLCARE STANDARD"]
["WELLSENSE","WELLSENSE CHOICE"]
["WELLSENSE","WELLSENSE CLARITY BRONZE"]
["WELLSENSE","WELLSENSE CLARITY GOLD"]
["WELLSENSE","WELLSENSE CLARITY PLAN TYPE 1"]
["WELLSENSE","WELLSENSE CLARITY PLAN TYPE 2"]
["WELLSENSE","WELLSENSE CLARITY PLAN TYPE 3"]
["WELLSENSE","WELLSENSE CLARITY PLATINUM"]
["WELLSENSE","WELLSENSE CLARITY SILVER"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO BI/LAHEY"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO CHILDRENS"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO COMM"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO EAST BOSTON"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO MERCY"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO SIG"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO SOUTH COAST"]
["WELLSENSE ALLI ACO","WELLSENSE CARE ALLIANCE"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM COMMONHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM FAM ASSIST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM STANDARD"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY COMMONHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY FAM ASSIST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY STANDARD"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY COMMONHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY FAM ASSIST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY STANDARD"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG COMMONHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG FAM ASSIST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG STANDARD"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO COMMNHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO FAM ASST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO STANDARD"]
["WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO CARE PLUS"]
["WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO COMMONHEALTH"]
["WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO FAMILY ASSIST"]
["WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO STANDARD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS"]
["WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP"]
["WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE"]
["WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT"]
["WORKERS COMP","WORKERS COMP CCMSI"]
["WORKERS COMP","WORKERS COMP CITY OF BOSTON"]
["WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS"]
["WORKERS COMP","WORKERS COMP COVE RISK"]
["WORKERS COMP","WORKERS COMP GALLAGHER BASSETT"]
["WORKERS COMP","WORKERS COMP GUARD INSURANCE"]
["WORKERS COMP","WORKERS COMP LIBERTY MUTUAL"]
["WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS"]
["WORKERS COMP","WORKERS COMP MBTA"]
["WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT"]
["WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS"]
["WORKERS COMP","WORKERS COMP STANDARD"]
["WORKERS COMP","WORKERS COMP THE HARTFORD"]
["WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR"]
["WORKERS COMP","ZZZWORKERS COMP AIG"]
["WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND"]
["WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS"]
["WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT"]
["WORKERS COMP","ZZZWORKERS COMP BROADSPIRE"]
["WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY"]
["ZZZAETNA","ZZZAETNA HMO"]
["ZZZAETNA","ZZZAETNA MCR SUPP"]
["ZZZAETNA","ZZZAETNA POS"]
["ZZZAETNA","ZZZAETNA PPO-EPO"]
["ZZZAETNA","ZZZAETNA STUDENT HEALTH"]
["ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD"]
["ZZZCCA ONECARE","ZZZCCA ONECARE"]
["ZZZCCA ONECARE","ZZZCCA SCO ONECARE"]
["ZZZCIGNA","CIGNA LOCALPLUS"]
["ZZZCIGNA","ZZZCIGNA CARELINK"]
["ZZZCIGNA","ZZZCIGNA STANDARD"]
["ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD"]
["ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD"]
["ZZZUNITED","ZZZUNITED DEFINITY HRA"]
["ZZZUNITED","ZZZUNITED HP SHIP"]
["ZZZUNITED","ZZZUNITED HP STUDENT HEALTH"]
["ZZZUNITED","ZZZUNITED PASSPORT CONNECT"]
["ZZZUNITED","ZZZUNITED STANDARD"]

{"sheet":"PayerPlanCount (CPT)","index":16,"n_rows":342,"n_cols":7,"rows_kept":342,"cut":false,"hidden":true,"merged":[]}
["Payer","Plan",null,null,null,"Row Labels","Count of Plan"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED",null,null,null,"CORRECTIONS",42]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO",null,null,null,"WELLSENSE ALLI ACO",28]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO",null,null,null,"TUFTS TOGETHER ACO",26]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD",null,null,null,"WORKERS COMP",23]
["AETNA","AETNA HMO",null,null,null,"MEDICAID ACO",16]
["AETNA","AETNA MCR SUPP",null,null,null,"FALLON HEALTHCRE ACO",16]
["AETNA","AETNA POS",null,null,null,"TUFTS CONNCARE/QHP",13]
["AETNA","AETNA PPO EPO",null,null,null,"MEDICAID",8]
["AETNA","AETNA STUDENT HEALTH",null,null,null,"WELLSENSE",8]
["AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD",null,null,null,"BCBS",7]
["BCBS","BCBS HMO",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED",6]
["BCBS","BCBS INDEMNITY",null,null,null,"UNITED",6]
["BCBS","BCBS POS",null,null,null,"HARVARD PILGRIM HEALTH CARE",6]
["BCBS","BCBS PPO",null,null,null,"TUFTS",6]
["BCBS","BCBS SHIP PPO",null,null,null,"MEDICAID MANAGED CARE",5]
["BCBS","BCBS STANDARD",null,null,null,"ZZZUNITED",5]
["BCBS","BLUE BENEFITS ADMINISTRATORS OF MA",null,null,null,"AETNA",5]
["BCBS MEDICARE MANAGED","BCBS MCR MNG HMO",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME",5]
["BCBS MEDICARE MANAGED","BCBS MCR MNG PPO",null,null,null,"ZZZAETNA",5]
["BCBS OUT OF STATE","BCBS OUT OF STATE HMO",null,null,null,"UNITED MEDICARE MANAGED",5]
["BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY",null,null,null,"TUFTS MEDICARE MANAGED",5]
["BCBS OUT OF STATE","BCBS OUT OF STATE POS",null,null,null,"WELLSENSE ESSENTIAL MCO",4]
["BCBS OUT OF STATE","BCBS OUT OF STATE PPO",null,null,null,"HEALTH PLANS INC",4]
["CCA","CCA SCO ONECARE",null,null,null,"ZZZHEALTH PLANS INC",4]
["CCA","CCA SCO STANDARD",null,null,null,"BCBS OUT OF STATE",4]
["CCA","ZZZCCA STANDARD",null,null,null,"TUFTS TOGETHER MCO",4]
["CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO",null,null,null,"MEDICARE",4]
["CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO",null,null,null,"AARP UHC MEDICARE COMPLETE",4]
["CCA MEDICARE PREFERRED","ZZZCCA",null,null,null,"FALLON",4]
["CIGNA","CIGNA CARELINK",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL",3]
["CIGNA","CIGNA LOCALPLUS",null,null,null,"WELLCARE",3]
["CIGNA","CIGNA STANDARD",null,null,null,"CIGNA",3]
["CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY",null,null,null,"CCA",3]
["CORRECTIONS","CORRECTIONS BRISTOL",null,null,null,"FALLON MEDICARE MANAGED",3]
["CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ",null,null,null,"CCA MEDICARE PREFERRED",3]
["CORRECTIONS","CORRECTIONS DEVENS PROGRAM",null,null,null,"ZZZCIGNA",3]
["CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC",null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN ACO",2]
["CORRECTIONS","CORRECTIONS ESSEX SALISBURY",null,null,null,"BCBS MEDICARE MANAGED",2]
["CORRECTIONS","CORRECTIONS HAMPDEN COUNTY",null,null,null,"HSN",2]
["CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS",null,null,null,"UNITED COMMUNITY PLAN",2]
["CORRECTIONS","CORRECTIONS ICE INMATE",null,null,null,"FALLON MEDICAID MANAGED",2]
["CORRECTIONS","CORRECTIONS MIDDLESEX",null,null,null,"WELLSENSE MEDICARE MANAGED",2]
["CORRECTIONS","CORRECTIONS NAPHCARE",null,null,null,"OXFORD HEALTH",2]
["CORRECTIONS","CORRECTIONS NASHUA",null,null,null,"ZZZCCA ONECARE",2]
["CORRECTIONS","CORRECTIONS NORFOLK",null,null,null,"SENIOR WHOLE HEALTH",2]
["CORRECTIONS","CORRECTIONS NORFOLK CTY CORR",null,null,null,"HSN PARTIAL",2]
["CORRECTIONS","CORRECTIONS PLYMOUTH",null,null,null,"TRICARE EAST",2]
["CORRECTIONS","CORRECTIONS PLYMOUTH CORR",null,null,null,"HSN CONFIDENTIAL",1]
["CORRECTIONS","CORRECTIONS SUFFOLK COUNTY",null,null,null,"HPHC MEDICARE MANAGED",1]
["CORRECTIONS","ZZZCORRECTIONS BAY STATE",null,null,null,"HUMANA MEDICARE",1]
["CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL",null,null,null,"ZZZCITY OF BOSTON WORK COMP",1]
["CORRECTIONS","ZZZCORRECTIONS BRADSTON",null,null,null,"MEDICAID LIMITED",1]
["CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST",null,null,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND",1]
["CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED",null,null,null,"HSN DENTAL",1]
["CORRECTIONS","ZZZCORRECTIONS CEDAR",null,null,null,"UBH HPHC",1]
["CORRECTIONS","ZZZCORRECTIONS CONCORD",null,null,null,"UNICARE",1]
["CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON",null,null,null,"TUFTS MEDICARE",1]
["CORRECTIONS","ZZZCORRECTIONS GARDNER",null,null,null,"ZZZBU EMPLOYEE WORK COMP",1]
["CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK",null,null,null,"FALLON SCO",1]
["CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL",null,null,null,"HSN BAD DEBT",1]
["CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR",null,null,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE",1]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL",null,null,null,"UPHAMS CORNER ESP",1]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB",null,null,null,"AETNA MEDICARE MANAGED",1]
["CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR",null,null,null,"TRICARE FOR LIFE",1]
["CORRECTIONS","ZZZCORRECTIONS NASHUA",null,null,null,"HLTH NEW ENGLAND ACO",1]
["CORRECTIONS","ZZZCORRECTIONS NORFOLK",null,null,null,"NEIGHBORHOOD PACE",1]
["CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR",null,null,null,"ZZZRAILROAD MEDICARE",1]
["CORRECTIONS","ZZZCORRECTIONS OLD COLONY",null,null,null,"Grand Total",341]
["CORRECTIONS","ZZZCORRECTIONS PLYMOUTH"]
["CORRECTIONS","ZZZCORRECTIONS PONDVILLE"]
["CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR"]
["CORRECTIONS","ZZZCORRECTIONS SHIRLEY"]
["CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI"]
["CORRECTIONS","ZZZORRECTIONS FRAMINGHAM"]
["FALLON","FALLON COMMUNITY PLAN"]
["FALLON","FALLON HMO STANDARD"]
["FALLON","FALLON POS STANDARD"]
["FALLON","FALLON PPO STANDARD"]
["FALLON HEALTHCRE ACO","FALLON HEALTHCARE ACO ATRIUS"]
["FALLON HEALTHCRE ACO","FALLON HEALTHCRE ACO BRKSHRE"]
["FALLON HEALTHCRE ACO","FALLON HEALTHCRE ACO RELIANT"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 CARE PLUS"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 COMMONHLTH"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 FAM ASSIST"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO 365 STANDARD"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE CAREPLUS"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE COMMHLTH"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE FAM ASST"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO BRKSHRE STANDARD"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WELLFORCE"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE CAREPLUS"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE COMMHLTH"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE FAM ASST"]
["FALLON HEALTHCRE ACO","ZZZFALLON HEALTHCRE ACO WLFORCE STANDARD"]
["FALLON MEDICAID MANAGED","FALLON MCD MNG CARE PLUS"]
["FALLON MEDICAID MANAGED","FALLON MCD MNG STANDARD"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG POS"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG PPO"]
["FALLON MEDICARE MANAGED","FALLON MCR MNG HMO"]
["FALLON SCO","FALLON SCO HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC PPO"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO"]
["HEALTH PLANS INC","HEALTH PLANS INC STANDARD"]
["HLTH NEW ENGLAND ACO","HLTH NEW ENGLAND ACO BE HEALTHY"]
["HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE"]
["HSN","HSN STANDARD"]
["HSN","HSN TEMPORARY"]
["HSN BAD DEBT","HSN BAD DEBT"]
["HSN CONFIDENTIAL","HSN CONFIDENTIAL"]
["HSN DENTAL","HSN DENTAL"]
["HSN PARTIAL","HSN PARTIAL STANDARD"]
["HSN PARTIAL","HSN PARTIAL TEMPORARY"]
["HUMANA MEDICARE","HUMANA MEDICARE STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","MASS GEN BRIG HLTH PLAN ACO MYCARE FAM"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","MASS GENERAL BRIG HLTH PLAN ACO STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG COMMON"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIG HLTHPLAN MCD MNG FAMASSIST"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGH HLTHPLAN MCD MNG CMA"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG BASIC"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM HLTH PLAN MCD MNG CARE"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","MASS GEN BRIGHAM MCD MNG STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE HMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 1"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 2"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN CONNCARE TYPE 3"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO"]
["MEDICAID","CMSP STANDARD"]
["MEDICAID","MEDICAID CARE PLUS"]
["MEDICAID","MEDICAID COMMONHEALTH"]
["MEDICAID","MEDICAID CORRECTIONS IP"]
["MEDICAID","MEDICAID EAEDC"]
["MEDICAID","MEDICAID FAMILY ASSIST"]
["MEDICAID","MEDICAID SENIOR BUY-IN"]
["MEDICAID","MEDICAID STANDARD"]
["MEDICAID ACO","MEDICAID ACO COMM"]
["MEDICAID ACO","MEDICAID ACO MASS GENERAL BRIG"]
["MEDICAID ACO","MEDICAID ACO STEWRD"]
["MEDICAID ACO","MEDICAID ACO STEWRD FAM ASSIS"]
["MEDICAID ACO","ZZZMEDICAID ACO COMM CARE PLUS"]
["MEDICAID ACO","ZZZMEDICAID ACO COMM COMMONHLTH"]
["MEDICAID ACO","ZZZMEDICAID ACO COMM FAM ASSIST"]
["MEDICAID ACO","ZZZMEDICAID ACO COMM STANDARD"]
["MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG CAREPLUS"]
["MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG COMMONHLT"]
["MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG FAM ASSIS"]
["MEDICAID ACO","ZZZMEDICAID ACO MASS GENERAL BRIG STANDARD"]
["MEDICAID ACO","ZZZMEDICAID ACO STEWRD CARE PLUS"]
["MEDICAID ACO","ZZZMEDICAID ACO STEWRD COMMONHLT"]
["MEDICAID ACO","ZZZMEDICAID ACO STEWRD FAM ASSIS"]
["MEDICAID ACO","ZZZMEDICAID ACO STEWRD STANDARD"]
["MEDICAID LIMITED","MEDICAID LIMITED LIMITED"]
["MEDICAID MANAGED CARE","MCD MNG CARE CARE PLUS"]
["MEDICAID MANAGED CARE","MCD MNG CARE COMMONHEALTH"]
["MEDICAID MANAGED CARE","MCD MNG CARE ESSENTIAL"]
["MEDICAID MANAGED CARE","MCD MNG CARE FAMILY ASSIST"]
["MEDICAID MANAGED CARE","MCD MNG CARE STANDARD"]
["MEDICARE","MEDICARE A&B"]
["MEDICARE","MEDICARE PART A ONLY"]
["MEDICARE","MEDICARE PART B ONLY"]
["MEDICARE","RAILROAD MEDICARE  RAILROAD"]
["NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD"]
["OXFORD HEALTH","OXFORD HEALTH STANDARD"]
["OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD"]
["SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD"]
["TRICARE EAST","TRICARE EAST PRIME (HMO)"]
["TRICARE EAST","TRICARE EAST SELECT"]
["TRICARE FOR LIFE","TRICARE FOR LIFE"]
["TUFTS","TUFTS CARELINK"]
["TUFTS","TUFTS HMO"]
["TUFTS","TUFTS POS"]
["TUFTS","TUFTS PPO"]
["TUFTS","TUFTS SELECT"]
["TUFTS","TUFTS SPIRIT"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED"]
["TUFTS MEDICARE","TUFTS MEDICARE HMO"]
["TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS"]
["TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS"]
["TUFTS TOGETHER ACO","TUFTS TOGETHER ACO CHA"]
["TUFTS TOGETHER ACO","TUFTS TOGETHER ACO UMASS MEMORIAL"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS COMMHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS FAM ASST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO ATRIUS STANDARD"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH COMMONHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH FAM ASSIST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BCH STANDARD"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO COMMONHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO FAM ASSIST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO BIDCO STANDARD"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA COMMONHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA FAM ASSIST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO CHA STANDARD"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY CARE PLUS"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY COMMONHLTH"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY FAM ASSIST"]
["TUFTS TOGETHER ACO","ZZZTUFTS TOGETHER ACO LAHEY STANDARD"]
["TUFTS TOGETHER MCO","TUFTS TOGETHER MCO"]
["TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO CARE PLUS"]
["TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO FAMILY ASSIST"]
["TUFTS TOGETHER MCO","ZZZTUFTS TOGETHER MCO STANDARD"]
["UBH HPHC","UBH HPHC"]
["UNICARE","UNICARE STANDARD"]
["UNITED","UNITED DEFINITY HRA"]
["UNITED","UNITED HP SHIP"]
["UNITED","UNITED HP STUDENT HEALTH"]
["UNITED","UNITED NAVIGATE"]
["UNITED","UNITED PASSPORT CONNECT"]
["UNITED","UNITED STANDARD"]
["UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO"]
["UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD"]
["UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG HMO"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG PPO"]
["UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO"]
["UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO"]
["UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD"]
["WELLCARE","WELLCARE HMO"]
["WELLCARE","WELLCARE PPO"]
["WELLCARE","WELLCARE STANDARD"]
["WELLSENSE","WELLSENSE CHOICE"]
["WELLSENSE","WELLSENSE CLARITY BRONZE"]
["WELLSENSE","WELLSENSE CLARITY GOLD"]
["WELLSENSE","WELLSENSE CLARITY PLAN TYPE 1"]
["WELLSENSE","WELLSENSE CLARITY PLAN TYPE 2"]
["WELLSENSE","WELLSENSE CLARITY PLAN TYPE 3"]
["WELLSENSE","WELLSENSE CLARITY PLATINUM"]
["WELLSENSE","WELLSENSE CLARITY SILVER"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO BI/LAHEY"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO CHILDRENS"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO COMM"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO EAST BOSTON"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO MERCY"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO SIG"]
["WELLSENSE ALLI ACO","WELLSENSE ALLI ACO SOUTH COAST"]
["WELLSENSE ALLI ACO","WELLSENSE CARE ALLIANCE"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM COMMONHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM FAM ASSIST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO COMM STANDARD"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY COMMONHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY FAM ASSIST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO LAHEY STANDARD"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY COMMONHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY FAM ASSIST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO MERCY STANDARD"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG COMMONHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG FAM ASSIST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO SIG STANDARD"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO CARE PLUS"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO COMMNHLTH"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO FAM ASST"]
["WELLSENSE ALLI ACO","ZZZBMC HP ALLI ACO STH CO STANDARD"]
["WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO CARE PLUS"]
["WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO COMMONHEALTH"]
["WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO FAMILY ASSIST"]
["WELLSENSE ESSENTIAL MCO","WELLSENSE ESSENTIAL MCO STANDARD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS"]
["WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP"]
["WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE"]
["WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT"]
["WORKERS COMP","WORKERS COMP CCMSI"]
["WORKERS COMP","WORKERS COMP CITY OF BOSTON"]
["WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS"]
["WORKERS COMP","WORKERS COMP COVE RISK"]
["WORKERS COMP","WORKERS COMP GALLAGHER BASSETT"]
["WORKERS COMP","WORKERS COMP GUARD INSURANCE"]
["WORKERS COMP","WORKERS COMP LIBERTY MUTUAL"]
["WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS"]
["WORKERS COMP","WORKERS COMP MBTA"]
["WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT"]
["WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS"]
["WORKERS COMP","WORKERS COMP STANDARD"]
["WORKERS COMP","WORKERS COMP THE HARTFORD"]
["WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR"]
["WORKERS COMP","ZZZWORKERS COMP AIG"]
["WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND"]
["WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS"]
["WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT"]
["WORKERS COMP","ZZZWORKERS COMP BROADSPIRE"]
["WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY"]
["ZZZAETNA","ZZZAETNA HMO"]
["ZZZAETNA","ZZZAETNA MCR SUPP"]
["ZZZAETNA","ZZZAETNA POS"]
["ZZZAETNA","ZZZAETNA PPO-EPO"]
["ZZZAETNA","ZZZAETNA STUDENT HEALTH"]
["ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD"]
["ZZZCCA ONECARE","ZZZCCA ONECARE"]
["ZZZCCA ONECARE","ZZZCCA SCO ONECARE"]
["ZZZCIGNA","CIGNA LOCALPLUS"]
["ZZZCIGNA","ZZZCIGNA CARELINK"]
["ZZZCIGNA","ZZZCIGNA STANDARD"]
["ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD"]
["ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD"]
["ZZZUNITED","ZZZUNITED DEFINITY HRA"]
["ZZZUNITED","ZZZUNITED HP SHIP"]
["ZZZUNITED","ZZZUNITED HP STUDENT HEALTH"]
["ZZZUNITED","ZZZUNITED PASSPORT CONNECT"]
["ZZZUNITED","ZZZUNITED STANDARD"]

{"sheet":"CPTPayer&Code&Desc","index":17,"n_rows":4348,"n_cols":71,"rows_kept":2250,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
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["AARP UHC MEDICARE COMPLETE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",null,null,"62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
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["AETNA","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["AETNA","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
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["AETNA","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["AETNA","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["AETNA","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["AETNA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["AETNA","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["AETNA","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
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["AETNA","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["AETNA","72148 - CHG MRI, LUMBAR SPINE"]
["AETNA","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["AETNA","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["AETNA","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
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["AETNA","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
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["AETNA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["AETNA","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["AETNA","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["AETNA","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["AETNA","80055 - CHG OBSTETRIC PANEL"]
["AETNA","80061 - CHG LIPID PANEL"]
["AETNA","80069 - CHG RENAL FUNCTION PANEL"]
["AETNA","80076 - CHG HEPATIC FUNCTION PANEL"]
["AETNA","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["AETNA","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["AETNA","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["AETNA","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["AETNA","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["AETNA","84443 - CHG ASSAY THYROID STIM HORMONE"]
["AETNA","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["AETNA","85027 - CHG COMPLETE CBC"]
["AETNA","85610 - CHG PROTHROMBIN TIME"]
["AETNA","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["AETNA","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["AETNA","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["AETNA","90715 - PR TDAP VACCINE >7 YO, IM"]
["AETNA","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["AETNA","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["AETNA","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["AETNA","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["AETNA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["AETNA","90853 - PR GROUP PSYCHOTHERAPY"]
["AETNA","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["AETNA","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["AETNA","97110 - PR THERAPEUTIC EXERCISES"]
["AETNA","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["AETNA","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["AETNA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["AETNA","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["AETNA","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["AETNA","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["AETNA","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["AETNA","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["AETNA","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["AETNA","A9500 - PR TC99M SESTAMIBI"]
["AETNA","A9513 - DELETED 2077"]
["AETNA","A9517 - PR I131 IODIDE CAP, RX"]
["AETNA","A9552 - PR F18 FDG"]
["AETNA","A9555 - PR RB82 RUBIDIUM"]
["AETNA","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["AETNA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["AETNA","A9581 - PR GADOXETATE DISODIUM INJ"]
["AETNA","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["AETNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AETNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AETNA","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["AETNA","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["AETNA","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["AETNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["AETNA MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["AETNA MEDICARE MANAGED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["AETNA MEDICARE MANAGED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["AETNA MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["AETNA MEDICARE MANAGED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["AETNA MEDICARE MANAGED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["AETNA MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["AETNA MEDICARE MANAGED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["AETNA MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["AETNA MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["AETNA MEDICARE MANAGED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["AETNA MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["AETNA MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["AETNA MEDICARE MANAGED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["AETNA MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["AETNA MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["AETNA MEDICARE MANAGED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["AETNA MEDICARE MANAGED","72148 - CHG MRI, LUMBAR SPINE"]
["AETNA MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["AETNA MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["AETNA MEDICARE MANAGED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["AETNA MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["AETNA MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["AETNA MEDICARE MANAGED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["AETNA MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["AETNA MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["AETNA MEDICARE MANAGED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["AETNA MEDICARE MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["AETNA MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["AETNA MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["AETNA MEDICARE MANAGED","80061 - CHG LIPID PANEL"]
["AETNA MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["AETNA MEDICARE MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["AETNA MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["AETNA MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["AETNA MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["AETNA MEDICARE MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["AETNA MEDICARE MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["AETNA MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["AETNA MEDICARE MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["AETNA MEDICARE MANAGED","85027 - CHG COMPLETE CBC"]
["AETNA MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["AETNA MEDICARE MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["AETNA MEDICARE MANAGED","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["AETNA MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["AETNA MEDICARE MANAGED","90715 - PR TDAP VACCINE >7 YO, IM"]
["AETNA MEDICARE MANAGED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["AETNA MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["AETNA MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["AETNA MEDICARE MANAGED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["AETNA MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["AETNA MEDICARE MANAGED","90853 - PR GROUP PSYCHOTHERAPY"]
["AETNA MEDICARE MANAGED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["AETNA MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["AETNA MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["AETNA MEDICARE MANAGED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["AETNA MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["AETNA MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["AETNA MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["AETNA MEDICARE MANAGED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["AETNA MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["AETNA MEDICARE MANAGED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["AETNA MEDICARE MANAGED","A9500 - PR TC99M SESTAMIBI"]
["AETNA MEDICARE MANAGED","A9513 - DELETED 2077"]
["AETNA MEDICARE MANAGED","A9517 - PR I131 IODIDE CAP, RX"]
["AETNA MEDICARE MANAGED","A9552 - PR F18 FDG"]
["AETNA MEDICARE MANAGED","A9555 - PR RB82 RUBIDIUM"]
["AETNA MEDICARE MANAGED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["AETNA MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["AETNA MEDICARE MANAGED","A9581 - PR GADOXETATE DISODIUM INJ"]
["AETNA MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["AETNA MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AETNA MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AETNA MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["AETNA MEDICARE MANAGED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["AETNA MEDICARE MANAGED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["AETNA MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS","19120 - PR EXCISE BREAST CYST"]
["BCBS","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["BCBS","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["BCBS","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["BCBS","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["BCBS","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["BCBS","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["BCBS","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["BCBS","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["BCBS","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["BCBS","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["BCBS","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["BCBS","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["BCBS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["BCBS","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["BCBS","70553 - CHG MRI BRAIN COMBO"]
["BCBS","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["BCBS","72148 - CHG MRI, LUMBAR SPINE"]
["BCBS","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["BCBS","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["BCBS","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["BCBS","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["BCBS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["BCBS","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["BCBS","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["BCBS","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["BCBS","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["BCBS","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["BCBS","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["BCBS","80055 - CHG OBSTETRIC PANEL"]
["BCBS","80061 - CHG LIPID PANEL"]
["BCBS","80069 - CHG RENAL FUNCTION PANEL"]
["BCBS","80076 - CHG HEPATIC FUNCTION PANEL"]
["BCBS","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["BCBS","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["BCBS","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["BCBS","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["BCBS","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["BCBS","84443 - CHG ASSAY THYROID STIM HORMONE"]
["BCBS","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["BCBS","85027 - CHG COMPLETE CBC"]
["BCBS","85610 - CHG PROTHROMBIN TIME"]
["BCBS","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["BCBS","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["BCBS","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["BCBS","90715 - PR TDAP VACCINE >7 YO, IM"]
["BCBS","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["BCBS","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["BCBS","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["BCBS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["BCBS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["BCBS","90853 - PR GROUP PSYCHOTHERAPY"]
["BCBS","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["BCBS","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["BCBS","97110 - PR THERAPEUTIC EXERCISES"]
["BCBS","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["BCBS","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["BCBS","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["BCBS","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["BCBS","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["BCBS","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["BCBS","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["BCBS","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["BCBS","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["BCBS","A9500 - PR TC99M SESTAMIBI"]
["BCBS","A9513 - DELETED 2077"]
["BCBS","A9517 - PR I131 IODIDE CAP, RX"]
["BCBS","A9552 - PR F18 FDG"]
["BCBS","A9555 - PR RB82 RUBIDIUM"]
["BCBS","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["BCBS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BCBS","A9581 - PR GADOXETATE DISODIUM INJ"]
["BCBS","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["BCBS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["BCBS","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["BCBS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BCBS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["BCBS MEDICARE MANAGED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["BCBS MEDICARE MANAGED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["BCBS MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["BCBS MEDICARE MANAGED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["BCBS MEDICARE MANAGED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["BCBS MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["BCBS MEDICARE MANAGED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["BCBS MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["BCBS MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["BCBS MEDICARE MANAGED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["BCBS MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["BCBS MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["BCBS MEDICARE MANAGED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["BCBS MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["BCBS MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["BCBS MEDICARE MANAGED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["BCBS MEDICARE MANAGED","72148 - CHG MRI, LUMBAR SPINE"]
["BCBS MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["BCBS MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["BCBS MEDICARE MANAGED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["BCBS MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["BCBS MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["BCBS MEDICARE MANAGED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["BCBS MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["BCBS MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["BCBS MEDICARE MANAGED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["BCBS MEDICARE MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["BCBS MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["BCBS MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["BCBS MEDICARE MANAGED","80061 - CHG LIPID PANEL"]
["BCBS MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["BCBS MEDICARE MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["BCBS MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["BCBS MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["BCBS MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["BCBS MEDICARE MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["BCBS MEDICARE MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["BCBS MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["BCBS MEDICARE MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["BCBS MEDICARE MANAGED","85027 - CHG COMPLETE CBC"]
["BCBS MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["BCBS MEDICARE MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["BCBS MEDICARE MANAGED","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["BCBS MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["BCBS MEDICARE MANAGED","90715 - PR TDAP VACCINE >7 YO, IM"]
["BCBS MEDICARE MANAGED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["BCBS MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["BCBS MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["BCBS MEDICARE MANAGED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["BCBS MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["BCBS MEDICARE MANAGED","90853 - PR GROUP PSYCHOTHERAPY"]
["BCBS MEDICARE MANAGED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["BCBS MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["BCBS MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["BCBS MEDICARE MANAGED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["BCBS MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["BCBS MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["BCBS MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["BCBS MEDICARE MANAGED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["BCBS MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["BCBS MEDICARE MANAGED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["BCBS MEDICARE MANAGED","A9500 - PR TC99M SESTAMIBI"]
["BCBS MEDICARE MANAGED","A9513 - DELETED 2077"]
["BCBS MEDICARE MANAGED","A9517 - PR I131 IODIDE CAP, RX"]
["BCBS MEDICARE MANAGED","A9552 - PR F18 FDG"]
["BCBS MEDICARE MANAGED","A9555 - PR RB82 RUBIDIUM"]
["BCBS MEDICARE MANAGED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["BCBS MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BCBS MEDICARE MANAGED","A9581 - PR GADOXETATE DISODIUM INJ"]
["BCBS MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["BCBS MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["BCBS MEDICARE MANAGED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["BCBS MEDICARE MANAGED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BCBS MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS OUT OF STATE","19120 - PR EXCISE BREAST CYST"]
["BCBS OUT OF STATE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["BCBS OUT OF STATE","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["BCBS OUT OF STATE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["BCBS OUT OF STATE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["BCBS OUT OF STATE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["BCBS OUT OF STATE","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["BCBS OUT OF STATE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["BCBS OUT OF STATE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["BCBS OUT OF STATE","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["BCBS OUT OF STATE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["BCBS OUT OF STATE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["BCBS OUT OF STATE","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["BCBS OUT OF STATE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["BCBS OUT OF STATE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["BCBS OUT OF STATE","70553 - CHG MRI BRAIN COMBO"]
["BCBS OUT OF STATE","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["BCBS OUT OF STATE","72148 - CHG MRI, LUMBAR SPINE"]
["BCBS OUT OF STATE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["BCBS OUT OF STATE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["BCBS OUT OF STATE","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["BCBS OUT OF STATE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["BCBS OUT OF STATE","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["BCBS OUT OF STATE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["BCBS OUT OF STATE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["BCBS OUT OF STATE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["BCBS OUT OF STATE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["BCBS OUT OF STATE","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["BCBS OUT OF STATE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["BCBS OUT OF STATE","80055 - CHG OBSTETRIC PANEL"]
["BCBS OUT OF STATE","80061 - CHG LIPID PANEL"]
["BCBS OUT OF STATE","80069 - CHG RENAL FUNCTION PANEL"]
["BCBS OUT OF STATE","80076 - CHG HEPATIC FUNCTION PANEL"]
["BCBS OUT OF STATE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["BCBS OUT OF STATE","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["BCBS OUT OF STATE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["BCBS OUT OF STATE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["BCBS OUT OF STATE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["BCBS OUT OF STATE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["BCBS OUT OF STATE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["BCBS OUT OF STATE","85027 - CHG COMPLETE CBC"]
["BCBS OUT OF STATE","85610 - CHG PROTHROMBIN TIME"]
["BCBS OUT OF STATE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["BCBS OUT OF STATE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["BCBS OUT OF STATE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["BCBS OUT OF STATE","90715 - PR TDAP VACCINE >7 YO, IM"]
["BCBS OUT OF STATE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["BCBS OUT OF STATE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["BCBS OUT OF STATE","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["BCBS OUT OF STATE","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["BCBS OUT OF STATE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["BCBS OUT OF STATE","90853 - PR GROUP PSYCHOTHERAPY"]
["BCBS OUT OF STATE","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["BCBS OUT OF STATE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["BCBS OUT OF STATE","97110 - PR THERAPEUTIC EXERCISES"]
["BCBS OUT OF STATE","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["BCBS OUT OF STATE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["BCBS OUT OF STATE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["BCBS OUT OF STATE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["BCBS OUT OF STATE","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["BCBS OUT OF STATE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["BCBS OUT OF STATE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["BCBS OUT OF STATE","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["BCBS OUT OF STATE","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["BCBS OUT OF STATE","A9500 - PR TC99M SESTAMIBI"]
["BCBS OUT OF STATE","A9513 - DELETED 2077"]
["BCBS OUT OF STATE","A9517 - PR I131 IODIDE CAP, RX"]
["BCBS OUT OF STATE","A9552 - PR F18 FDG"]
["BCBS OUT OF STATE","A9555 - PR RB82 RUBIDIUM"]
["BCBS OUT OF STATE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["BCBS OUT OF STATE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["BCBS OUT OF STATE","A9581 - PR GADOXETATE DISODIUM INJ"]
["BCBS OUT OF STATE","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["BCBS OUT OF STATE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS OUT OF STATE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS OUT OF STATE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["BCBS OUT OF STATE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["BCBS OUT OF STATE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["BCBS OUT OF STATE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CCA","19120 - PR EXCISE BREAST CYST"]
["CCA","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["CCA","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["CCA","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["CCA","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["CCA","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["CCA","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["CCA","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["CCA","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["CCA","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["CCA","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["CCA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["CCA","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["CCA","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["CCA","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["CCA","70553 - CHG MRI BRAIN COMBO"]
["CCA","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["CCA","72148 - CHG MRI, LUMBAR SPINE"]
["CCA","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["CCA","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["CCA","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["CCA","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["CCA","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["CCA","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["CCA","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["CCA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["CCA","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["CCA","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["CCA","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["CCA","80055 - CHG OBSTETRIC PANEL"]
["CCA","80061 - CHG LIPID PANEL"]
["CCA","80069 - CHG RENAL FUNCTION PANEL"]
["CCA","80076 - CHG HEPATIC FUNCTION PANEL"]
["CCA","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["CCA","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["CCA","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["CCA","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["CCA","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["CCA","84443 - CHG ASSAY THYROID STIM HORMONE"]
["CCA","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["CCA","85027 - CHG COMPLETE CBC"]
["CCA","85610 - CHG PROTHROMBIN TIME"]
["CCA","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["CCA","90715 - PR TDAP VACCINE >7 YO, IM"]
["CCA","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["CCA","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["CCA","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["CCA","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["CCA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["CCA","90853 - PR GROUP PSYCHOTHERAPY"]
["CCA","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["CCA","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["CCA","97110 - PR THERAPEUTIC EXERCISES"]
["CCA","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["CCA","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["CCA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["CCA","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["CCA","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["CCA","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["CCA","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["CCA","A9500 - PR TC99M SESTAMIBI"]
["CCA","A9513 - DELETED 2077"]
["CCA","A9517 - PR I131 IODIDE CAP, RX"]
["CCA","A9552 - PR F18 FDG"]
["CCA","A9555 - PR RB82 RUBIDIUM"]
["CCA","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["CCA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CCA","A9581 - PR GADOXETATE DISODIUM INJ"]
["CCA","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["CCA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CCA","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["CCA","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["CCA","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CCA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CCA MEDICARE PREFERRED","19120 - PR EXCISE BREAST CYST"]
["CCA MEDICARE PREFERRED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["CCA MEDICARE PREFERRED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["CCA MEDICARE PREFERRED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["CCA MEDICARE PREFERRED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["CCA MEDICARE PREFERRED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["CCA MEDICARE PREFERRED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["CCA MEDICARE PREFERRED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["CCA MEDICARE PREFERRED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["CCA MEDICARE PREFERRED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["CCA MEDICARE PREFERRED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["CCA MEDICARE PREFERRED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["CCA MEDICARE PREFERRED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["CCA MEDICARE PREFERRED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["CCA MEDICARE PREFERRED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["CCA MEDICARE PREFERRED","70553 - CHG MRI BRAIN COMBO"]
["CCA MEDICARE PREFERRED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["CCA MEDICARE PREFERRED","72148 - CHG MRI, LUMBAR SPINE"]
["CCA MEDICARE PREFERRED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["CCA MEDICARE PREFERRED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["CCA MEDICARE PREFERRED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["CCA MEDICARE PREFERRED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["CCA MEDICARE PREFERRED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["CCA MEDICARE PREFERRED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["CCA MEDICARE PREFERRED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["CCA MEDICARE PREFERRED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["CCA MEDICARE PREFERRED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["CCA MEDICARE PREFERRED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["CCA MEDICARE PREFERRED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["CCA MEDICARE PREFERRED","80055 - CHG OBSTETRIC PANEL"]
["CCA MEDICARE PREFERRED","80061 - CHG LIPID PANEL"]
["CCA MEDICARE PREFERRED","80069 - CHG RENAL FUNCTION PANEL"]
["CCA MEDICARE PREFERRED","80076 - CHG HEPATIC FUNCTION PANEL"]
["CCA MEDICARE PREFERRED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["CCA MEDICARE PREFERRED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["CCA MEDICARE PREFERRED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["CCA MEDICARE PREFERRED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["CCA MEDICARE PREFERRED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["CCA MEDICARE PREFERRED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["CCA MEDICARE PREFERRED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["CCA MEDICARE PREFERRED","85027 - CHG COMPLETE CBC"]
["CCA MEDICARE PREFERRED","85610 - CHG PROTHROMBIN TIME"]
["CCA MEDICARE PREFERRED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["CCA MEDICARE PREFERRED","90715 - PR TDAP VACCINE >7 YO, IM"]
["CCA MEDICARE PREFERRED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["CCA MEDICARE PREFERRED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["CCA MEDICARE PREFERRED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["CCA MEDICARE PREFERRED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["CCA MEDICARE PREFERRED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["CCA MEDICARE PREFERRED","90853 - PR GROUP PSYCHOTHERAPY"]
["CCA MEDICARE PREFERRED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["CCA MEDICARE PREFERRED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["CCA MEDICARE PREFERRED","97110 - PR THERAPEUTIC EXERCISES"]
["CCA MEDICARE PREFERRED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["CCA MEDICARE PREFERRED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["CCA MEDICARE PREFERRED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["CCA MEDICARE PREFERRED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["CCA MEDICARE PREFERRED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["CCA MEDICARE PREFERRED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["CCA MEDICARE PREFERRED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["CCA MEDICARE PREFERRED","A9500 - PR TC99M SESTAMIBI"]
["CCA MEDICARE PREFERRED","A9513 - DELETED 2077"]
["CCA MEDICARE PREFERRED","A9517 - PR I131 IODIDE CAP, RX"]
["CCA MEDICARE PREFERRED","A9552 - PR F18 FDG"]
["CCA MEDICARE PREFERRED","A9555 - PR RB82 RUBIDIUM"]
["CCA MEDICARE PREFERRED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["CCA MEDICARE PREFERRED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CCA MEDICARE PREFERRED","A9581 - PR GADOXETATE DISODIUM INJ"]
["CCA MEDICARE PREFERRED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["CCA MEDICARE PREFERRED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA MEDICARE PREFERRED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CCA MEDICARE PREFERRED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["CCA MEDICARE PREFERRED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["CCA MEDICARE PREFERRED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CCA MEDICARE PREFERRED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CIGNA","19120 - PR EXCISE BREAST CYST"]
["CIGNA","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["CIGNA","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["CIGNA","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["CIGNA","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["CIGNA","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["CIGNA","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["CIGNA","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["CIGNA","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["CIGNA","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["CIGNA","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["CIGNA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["CIGNA","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["CIGNA","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["CIGNA","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["CIGNA","70553 - CHG MRI BRAIN COMBO"]
["CIGNA","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["CIGNA","72148 - CHG MRI, LUMBAR SPINE"]
["CIGNA","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["CIGNA","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["CIGNA","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["CIGNA","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["CIGNA","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["CIGNA","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["CIGNA","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["CIGNA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["CIGNA","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["CIGNA","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["CIGNA","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["CIGNA","80055 - CHG OBSTETRIC PANEL"]
["CIGNA","80061 - CHG LIPID PANEL"]
["CIGNA","80069 - CHG RENAL FUNCTION PANEL"]
["CIGNA","80076 - CHG HEPATIC FUNCTION PANEL"]
["CIGNA","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["CIGNA","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["CIGNA","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["CIGNA","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["CIGNA","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["CIGNA","84443 - CHG ASSAY THYROID STIM HORMONE"]
["CIGNA","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["CIGNA","85027 - CHG COMPLETE CBC"]
["CIGNA","85610 - CHG PROTHROMBIN TIME"]
["CIGNA","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["CIGNA","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["CIGNA","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["CIGNA","90715 - PR TDAP VACCINE >7 YO, IM"]
["CIGNA","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["CIGNA","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["CIGNA","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["CIGNA","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["CIGNA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["CIGNA","90853 - PR GROUP PSYCHOTHERAPY"]
["CIGNA","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["CIGNA","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["CIGNA","97110 - PR THERAPEUTIC EXERCISES"]
["CIGNA","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["CIGNA","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["CIGNA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["CIGNA","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["CIGNA","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["CIGNA","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["CIGNA","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["CIGNA","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["CIGNA","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["CIGNA","A9500 - PR TC99M SESTAMIBI"]
["CIGNA","A9513 - DELETED 2077"]
["CIGNA","A9517 - PR I131 IODIDE CAP, RX"]
["CIGNA","A9552 - PR F18 FDG"]
["CIGNA","A9555 - PR RB82 RUBIDIUM"]
["CIGNA","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["CIGNA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CIGNA","A9581 - PR GADOXETATE DISODIUM INJ"]
["CIGNA","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["CIGNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CIGNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CIGNA","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["CIGNA","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["CIGNA","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CIGNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CORRECTIONS","19120 - PR EXCISE BREAST CYST"]
["CORRECTIONS","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["CORRECTIONS","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["CORRECTIONS","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["CORRECTIONS","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["CORRECTIONS","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["CORRECTIONS","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["CORRECTIONS","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["CORRECTIONS","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["CORRECTIONS","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["CORRECTIONS","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["CORRECTIONS","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["CORRECTIONS","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["CORRECTIONS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["CORRECTIONS","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["CORRECTIONS","70553 - CHG MRI BRAIN COMBO"]
["CORRECTIONS","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["CORRECTIONS","72148 - CHG MRI, LUMBAR SPINE"]
["CORRECTIONS","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["CORRECTIONS","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["CORRECTIONS","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["CORRECTIONS","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["CORRECTIONS","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["CORRECTIONS","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["CORRECTIONS","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["CORRECTIONS","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["CORRECTIONS","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["CORRECTIONS","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["CORRECTIONS","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["CORRECTIONS","80055 - CHG OBSTETRIC PANEL"]
["CORRECTIONS","80061 - CHG LIPID PANEL"]
["CORRECTIONS","80069 - CHG RENAL FUNCTION PANEL"]
["CORRECTIONS","80076 - CHG HEPATIC FUNCTION PANEL"]
["CORRECTIONS","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["CORRECTIONS","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["CORRECTIONS","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["CORRECTIONS","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["CORRECTIONS","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["CORRECTIONS","84443 - CHG ASSAY THYROID STIM HORMONE"]
["CORRECTIONS","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["CORRECTIONS","85027 - CHG COMPLETE CBC"]
["CORRECTIONS","85610 - CHG PROTHROMBIN TIME"]
["CORRECTIONS","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["CORRECTIONS","90715 - PR TDAP VACCINE >7 YO, IM"]
["CORRECTIONS","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["CORRECTIONS","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["CORRECTIONS","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["CORRECTIONS","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["CORRECTIONS","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["CORRECTIONS","90853 - PR GROUP PSYCHOTHERAPY"]
["CORRECTIONS","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["CORRECTIONS","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["CORRECTIONS","97110 - PR THERAPEUTIC EXERCISES"]
["CORRECTIONS","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["CORRECTIONS","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["CORRECTIONS","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["CORRECTIONS","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["CORRECTIONS","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["CORRECTIONS","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["CORRECTIONS","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["CORRECTIONS","A9500 - PR TC99M SESTAMIBI"]
["CORRECTIONS","A9513 - DELETED 2077"]
["CORRECTIONS","A9517 - PR I131 IODIDE CAP, RX"]
["CORRECTIONS","A9552 - PR F18 FDG"]
["CORRECTIONS","A9555 - PR RB82 RUBIDIUM"]
["CORRECTIONS","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["CORRECTIONS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["CORRECTIONS","A9581 - PR GADOXETATE DISODIUM INJ"]
["CORRECTIONS","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["CORRECTIONS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CORRECTIONS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CORRECTIONS","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["CORRECTIONS","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["CORRECTIONS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["CORRECTIONS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON","19120 - PR EXCISE BREAST CYST"]
["FALLON","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["FALLON","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["FALLON","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["FALLON","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["FALLON","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["FALLON","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["FALLON","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["FALLON","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["FALLON","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["FALLON","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["FALLON","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["FALLON","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["FALLON","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["FALLON","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["FALLON","70553 - CHG MRI BRAIN COMBO"]
["FALLON","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["FALLON","72148 - CHG MRI, LUMBAR SPINE"]
["FALLON","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["FALLON","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["FALLON","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["FALLON","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["FALLON","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["FALLON","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["FALLON","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["FALLON","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["FALLON","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["FALLON","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON","80055 - CHG OBSTETRIC PANEL"]
["FALLON","80061 - CHG LIPID PANEL"]
["FALLON","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON","85027 - CHG COMPLETE CBC"]
["FALLON","85610 - CHG PROTHROMBIN TIME"]
["FALLON","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["FALLON","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["FALLON","90715 - PR TDAP VACCINE >7 YO, IM"]
["FALLON","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["FALLON","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["FALLON","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["FALLON","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["FALLON","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["FALLON","90853 - PR GROUP PSYCHOTHERAPY"]
["FALLON","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["FALLON","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["FALLON","97110 - PR THERAPEUTIC EXERCISES"]
["FALLON","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["FALLON","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["FALLON","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["FALLON","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["FALLON","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["FALLON","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["FALLON","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["FALLON","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["FALLON","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["FALLON","A9500 - PR TC99M SESTAMIBI"]
["FALLON","A9513 - DELETED 2077"]
["FALLON","A9517 - PR I131 IODIDE CAP, RX"]
["FALLON","A9552 - PR F18 FDG"]
["FALLON","A9555 - PR RB82 RUBIDIUM"]
["FALLON","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["FALLON","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["FALLON","A9581 - PR GADOXETATE DISODIUM INJ"]
["FALLON","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["FALLON","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["FALLON","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["FALLON","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["FALLON","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON HEALTHCRE ACO","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON HEALTHCRE ACO","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON HEALTHCRE ACO","80055 - CHG OBSTETRIC PANEL"]
["FALLON HEALTHCRE ACO","80061 - CHG LIPID PANEL"]
["FALLON HEALTHCRE ACO","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON HEALTHCRE ACO","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON HEALTHCRE ACO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON HEALTHCRE ACO","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON HEALTHCRE ACO","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON HEALTHCRE ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON HEALTHCRE ACO","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON HEALTHCRE ACO","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON HEALTHCRE ACO","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON HEALTHCRE ACO","85027 - CHG COMPLETE CBC"]
["FALLON HEALTHCRE ACO","85610 - CHG PROTHROMBIN TIME"]
["FALLON HEALTHCRE ACO","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON MEDICAID MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON MEDICAID MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON MEDICAID MANAGED","80055 - CHG OBSTETRIC PANEL"]
["FALLON MEDICAID MANAGED","80061 - CHG LIPID PANEL"]
["FALLON MEDICAID MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON MEDICAID MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON MEDICAID MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON MEDICAID MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON MEDICAID MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON MEDICAID MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON MEDICAID MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON MEDICAID MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON MEDICAID MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON MEDICAID MANAGED","85027 - CHG COMPLETE CBC"]
["FALLON MEDICAID MANAGED","85610 - CHG PROTHROMBIN TIME"]
["FALLON MEDICAID MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["FALLON MEDICARE MANAGED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["FALLON MEDICARE MANAGED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["FALLON MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["FALLON MEDICARE MANAGED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["FALLON MEDICARE MANAGED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["FALLON MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["FALLON MEDICARE MANAGED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["FALLON MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["FALLON MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["FALLON MEDICARE MANAGED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["FALLON MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["FALLON MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["FALLON MEDICARE MANAGED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["FALLON MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["FALLON MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["FALLON MEDICARE MANAGED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["FALLON MEDICARE MANAGED","72148 - CHG MRI, LUMBAR SPINE"]
["FALLON MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["FALLON MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["FALLON MEDICARE MANAGED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["FALLON MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["FALLON MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["FALLON MEDICARE MANAGED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["FALLON MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["FALLON MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["FALLON MEDICARE MANAGED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["FALLON MEDICARE MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["FALLON MEDICARE MANAGED","80061 - CHG LIPID PANEL"]
["FALLON MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON MEDICARE MANAGED","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON MEDICARE MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON MEDICARE MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON MEDICARE MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON MEDICARE MANAGED","85027 - CHG COMPLETE CBC"]
["FALLON MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["FALLON MEDICARE MANAGED","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["FALLON MEDICARE MANAGED","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["FALLON MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["FALLON MEDICARE MANAGED","90715 - PR TDAP VACCINE >7 YO, IM"]
["FALLON MEDICARE MANAGED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["FALLON MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["FALLON MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["FALLON MEDICARE MANAGED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["FALLON MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["FALLON MEDICARE MANAGED","90853 - PR GROUP PSYCHOTHERAPY"]
["FALLON MEDICARE MANAGED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["FALLON MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["FALLON MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["FALLON MEDICARE MANAGED","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["FALLON MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["FALLON MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["FALLON MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["FALLON MEDICARE MANAGED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["FALLON MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["FALLON MEDICARE MANAGED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["FALLON MEDICARE MANAGED","A9500 - PR TC99M SESTAMIBI"]
["FALLON MEDICARE MANAGED","A9513 - DELETED 2077"]
["FALLON MEDICARE MANAGED","A9517 - PR I131 IODIDE CAP, RX"]
["FALLON MEDICARE MANAGED","A9552 - PR F18 FDG"]
["FALLON MEDICARE MANAGED","A9555 - PR RB82 RUBIDIUM"]
["FALLON MEDICARE MANAGED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["FALLON MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["FALLON MEDICARE MANAGED","A9581 - PR GADOXETATE DISODIUM INJ"]
["FALLON MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["FALLON MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["FALLON MEDICARE MANAGED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["FALLON MEDICARE MANAGED","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["FALLON MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON SCO","19120 - PR EXCISE BREAST CYST"]
["FALLON SCO","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["FALLON SCO","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["FALLON SCO","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["FALLON SCO","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["FALLON SCO","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["FALLON SCO","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["FALLON SCO","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["FALLON SCO","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["FALLON SCO","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["FALLON SCO","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["FALLON SCO","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["FALLON SCO","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["FALLON SCO","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["FALLON SCO","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["FALLON SCO","70553 - CHG MRI BRAIN COMBO"]
["FALLON SCO","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["FALLON SCO","72148 - CHG MRI, LUMBAR SPINE"]
["FALLON SCO","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["FALLON SCO","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["FALLON SCO","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["FALLON SCO","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["FALLON SCO","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["FALLON SCO","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["FALLON SCO","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["FALLON SCO","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["FALLON SCO","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["FALLON SCO","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["FALLON SCO","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["FALLON SCO","80055 - CHG OBSTETRIC PANEL"]
["FALLON SCO","80061 - CHG LIPID PANEL"]
["FALLON SCO","80069 - CHG RENAL FUNCTION PANEL"]
["FALLON SCO","80076 - CHG HEPATIC FUNCTION PANEL"]
["FALLON SCO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["FALLON SCO","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["FALLON SCO","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["FALLON SCO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["FALLON SCO","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["FALLON SCO","84443 - CHG ASSAY THYROID STIM HORMONE"]
["FALLON SCO","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["FALLON SCO","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["FALLON SCO","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["FALLON SCO","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["FALLON SCO","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["FALLON SCO","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["FALLON SCO","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["FALLON SCO","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["FALLON SCO","A9517 - PR I131 IODIDE CAP, RX"]
["FALLON SCO","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["FALLON SCO","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON SCO","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["HARVARD PILGRIM HEALTH CARE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["HARVARD PILGRIM HEALTH CARE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["HARVARD PILGRIM HEALTH CARE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["HARVARD PILGRIM HEALTH CARE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["HARVARD PILGRIM HEALTH CARE","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["HARVARD PILGRIM HEALTH CARE","70553 - CHG MRI BRAIN COMBO"]
["HARVARD PILGRIM HEALTH CARE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["HARVARD PILGRIM HEALTH CARE","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["HARVARD PILGRIM HEALTH CARE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["HARVARD PILGRIM HEALTH CARE","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["HARVARD PILGRIM HEALTH CARE","80061 - CHG LIPID PANEL"]
["HARVARD PILGRIM HEALTH CARE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["HARVARD PILGRIM HEALTH CARE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["HARVARD PILGRIM HEALTH CARE","85027 - CHG COMPLETE CBC"]
["HARVARD PILGRIM HEALTH CARE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HARVARD PILGRIM HEALTH CARE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["HARVARD PILGRIM HEALTH CARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["HARVARD PILGRIM HEALTH CARE","90853 - PR GROUP PSYCHOTHERAPY"]
["HARVARD PILGRIM HEALTH CARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["HARVARD PILGRIM HEALTH CARE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["HARVARD PILGRIM HEALTH CARE","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["HARVARD PILGRIM HEALTH CARE","A9513 - DELETED 2077"]
["HARVARD PILGRIM HEALTH CARE","A9555 - PR RB82 RUBIDIUM"]
["HARVARD PILGRIM HEALTH CARE","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["HARVARD PILGRIM HEALTH CARE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["HARVARD PILGRIM HEALTH CARE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["HEALTH PLANS INC","19120 - PR EXCISE BREAST CYST"]
["HEALTH PLANS INC","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["HEALTH PLANS INC","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["HEALTH PLANS INC","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["HEALTH PLANS INC","70553 - CHG MRI BRAIN COMBO"]
["HEALTH PLANS INC","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["HEALTH PLANS INC","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["HEALTH PLANS INC","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["HEALTH PLANS INC","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["HEALTH PLANS INC","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["HEALTH PLANS INC","80076 - CHG HEPATIC FUNCTION PANEL"]
["HEALTH PLANS INC","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["HEALTH PLANS INC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["HEALTH PLANS INC","85027 - CHG COMPLETE CBC"]
["HEALTH PLANS INC","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["HEALTH PLANS INC","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["HEALTH PLANS INC","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["HEALTH PLANS INC","97110 - PR THERAPEUTIC EXERCISES"]
["HEALTH PLANS INC","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["HEALTH PLANS INC","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["HEALTH PLANS INC","A9500 - PR TC99M SESTAMIBI"]
["HEALTH PLANS INC","A9552 - PR F18 FDG"]
["HEALTH PLANS INC","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HEALTH PLANS INC","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HEALTH PLANS INC","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["HLTH NEW ENGLAND ACO","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["HLTH NEW ENGLAND ACO","80061 - CHG LIPID PANEL"]
["HLTH NEW ENGLAND ACO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["HLTH NEW ENGLAND ACO","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["HLTH NEW ENGLAND ACO","85027 - CHG COMPLETE CBC"]
["HPHC MEDICARE MANAGED","19120 - PR EXCISE BREAST CYST"]
["HPHC MEDICARE MANAGED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["HPHC MEDICARE MANAGED","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["HPHC MEDICARE MANAGED","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["HPHC MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["HPHC MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["HPHC MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["HPHC MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["HPHC MEDICARE MANAGED","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["HPHC MEDICARE MANAGED","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["HPHC MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["HPHC MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["HPHC MEDICARE MANAGED","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["HPHC MEDICARE MANAGED","85027 - CHG COMPLETE CBC"]
["HPHC MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HPHC MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["HPHC MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["HPHC MEDICARE MANAGED","90853 - PR GROUP PSYCHOTHERAPY"]
["HPHC MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["HPHC MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["HPHC MEDICARE MANAGED","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["HPHC MEDICARE MANAGED","A9517 - PR I131 IODIDE CAP, RX"]
["HPHC MEDICARE MANAGED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HPHC MEDICARE MANAGED","A9581 - PR GADOXETATE DISODIUM INJ"]
["HPHC MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["HPHC MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["HSN","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["HSN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["HSN","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["HSN","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["HSN","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["HSN","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["HSN","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["HSN","80055 - CHG OBSTETRIC PANEL"]
["HSN","80069 - CHG RENAL FUNCTION PANEL"]
["HSN","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["HSN","84443 - CHG ASSAY THYROID STIM HORMONE"]
["HSN","85610 - CHG PROTHROMBIN TIME"]
["HSN","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HSN","90715 - PR TDAP VACCINE >7 YO, IM"]
["HSN","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["HSN","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["HSN","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["HSN","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["HSN","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["HSN","A9517 - PR I131 IODIDE CAP, RX"]
["HSN","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["HSN","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HSN","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["HSN BAD DEBT","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["HSN BAD DEBT","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["HSN BAD DEBT","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["HSN BAD DEBT","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["HSN BAD DEBT","70553 - CHG MRI BRAIN COMBO"]
["HSN BAD DEBT","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["HSN BAD DEBT","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["HSN BAD DEBT","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["HSN BAD DEBT","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["HSN BAD DEBT","80055 - CHG OBSTETRIC PANEL"]
["HSN BAD DEBT","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["HSN BAD DEBT","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["HSN BAD DEBT","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["HSN BAD DEBT","85610 - CHG PROTHROMBIN TIME"]
["HSN BAD DEBT","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HSN BAD DEBT","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["HSN BAD DEBT","90853 - PR GROUP PSYCHOTHERAPY"]
["HSN BAD DEBT","97110 - PR THERAPEUTIC EXERCISES"]
["HSN BAD DEBT","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["HSN BAD DEBT","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["HSN BAD DEBT","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["HSN BAD DEBT","A9513 - DELETED 2077"]
["HSN BAD DEBT","A9555 - PR RB82 RUBIDIUM"]
["HSN BAD DEBT","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN BAD DEBT","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["HSN CONFIDENTIAL","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["HSN CONFIDENTIAL","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["HSN CONFIDENTIAL","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["HSN CONFIDENTIAL","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["HSN CONFIDENTIAL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["HSN CONFIDENTIAL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["HSN CONFIDENTIAL","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["HSN CONFIDENTIAL","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["HSN CONFIDENTIAL","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["HSN CONFIDENTIAL","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["HSN CONFIDENTIAL","80076 - CHG HEPATIC FUNCTION PANEL"]
["HSN CONFIDENTIAL","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["HSN CONFIDENTIAL","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["HSN CONFIDENTIAL","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["HSN CONFIDENTIAL","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HSN CONFIDENTIAL","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["HSN CONFIDENTIAL","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["HSN CONFIDENTIAL","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["HSN CONFIDENTIAL","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["HSN CONFIDENTIAL","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["HSN CONFIDENTIAL","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["HSN CONFIDENTIAL","A9513 - DELETED 2077"]
["HSN CONFIDENTIAL","A9555 - PR RB82 RUBIDIUM"]
["HSN CONFIDENTIAL","A9581 - PR GADOXETATE DISODIUM INJ"]
["HSN CONFIDENTIAL","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["HSN CONFIDENTIAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN DENTAL","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["HSN DENTAL","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["HSN DENTAL","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["HSN DENTAL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["HSN DENTAL","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["HSN DENTAL","72148 - CHG MRI, LUMBAR SPINE"]
["HSN DENTAL","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["HSN DENTAL","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["HSN DENTAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["HSN DENTAL","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["HSN DENTAL","80069 - CHG RENAL FUNCTION PANEL"]
["HSN DENTAL","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["HSN DENTAL","84443 - CHG ASSAY THYROID STIM HORMONE"]
["HSN DENTAL","85027 - CHG COMPLETE CBC"]
["HSN DENTAL","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["HSN DENTAL","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["HSN DENTAL","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["HSN DENTAL","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["HSN DENTAL","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["HSN DENTAL","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["HSN DENTAL","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["HSN DENTAL","A9517 - PR I131 IODIDE CAP, RX"]
["HSN DENTAL","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HSN DENTAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN DENTAL","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["HSN DENTAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN PARTIAL","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["HSN PARTIAL","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["HSN PARTIAL","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["HSN PARTIAL","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["HSN PARTIAL","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["HSN PARTIAL","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["HSN PARTIAL","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["HSN PARTIAL","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["HSN PARTIAL","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["HSN PARTIAL","80069 - CHG RENAL FUNCTION PANEL"]
["HSN PARTIAL","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["HSN PARTIAL","84443 - CHG ASSAY THYROID STIM HORMONE"]
["HSN PARTIAL","85610 - CHG PROTHROMBIN TIME"]
["HSN PARTIAL","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HSN PARTIAL","90715 - PR TDAP VACCINE >7 YO, IM"]
["HSN PARTIAL","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["HSN PARTIAL","90853 - PR GROUP PSYCHOTHERAPY"]
["HSN PARTIAL","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["HSN PARTIAL","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["HSN PARTIAL","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["HSN PARTIAL","A9517 - PR I131 IODIDE CAP, RX"]
["HSN PARTIAL","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["HSN PARTIAL","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HSN PARTIAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN PARTIAL","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["HUMANA MEDICARE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["HUMANA MEDICARE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["HUMANA MEDICARE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["HUMANA MEDICARE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["HUMANA MEDICARE","70553 - CHG MRI BRAIN COMBO"]
["HUMANA MEDICARE","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["HUMANA MEDICARE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["HUMANA MEDICARE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["HUMANA MEDICARE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["HUMANA MEDICARE","80055 - CHG OBSTETRIC PANEL"]
["HUMANA MEDICARE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["HUMANA MEDICARE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["HUMANA MEDICARE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["HUMANA MEDICARE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["HUMANA MEDICARE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["HUMANA MEDICARE","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["HUMANA MEDICARE","90853 - PR GROUP PSYCHOTHERAPY"]
["HUMANA MEDICARE","97110 - PR THERAPEUTIC EXERCISES"]
["HUMANA MEDICARE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["HUMANA MEDICARE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["HUMANA MEDICARE","A9500 - PR TC99M SESTAMIBI"]
["HUMANA MEDICARE","A9552 - PR F18 FDG"]
["HUMANA MEDICARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["HUMANA MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HUMANA MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","80055 - CHG OBSTETRIC PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["MASS GENERAL BRIGHAM HEALTH PLAN ACO","85027 - CHG COMPLETE CBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","19120 - PR EXCISE BREAST CYST"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","80055 - CHG OBSTETRIC PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","80076 - CHG HEPATIC FUNCTION PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","90715 - PR TDAP VACCINE >7 YO, IM"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","97110 - PR THERAPEUTIC EXERCISES"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9500 - PR TC99M SESTAMIBI"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9552 - PR F18 FDG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9555 - PR RB82 RUBIDIUM"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9581 - PR GADOXETATE DISODIUM INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","80061 - CHG LIPID PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","85027 - CHG COMPLETE CBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED","85610 - CHG PROTHROMBIN TIME"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","80061 - CHG LIPID PANEL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","85027 - CHG COMPLETE CBC"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","85610 - CHG PROTHROMBIN TIME"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","90715 - PR TDAP VACCINE >7 YO, IM"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","90853 - PR GROUP PSYCHOTHERAPY"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","A9513 - DELETED 2077"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","A9555 - PR RB82 RUBIDIUM"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MEDICAID","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["MEDICAID","80069 - CHG RENAL FUNCTION PANEL"]
["MEDICAID","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["MEDICAID","84443 - CHG ASSAY THYROID STIM HORMONE"]
["MEDICAID","85610 - CHG PROTHROMBIN TIME"]
["MEDICAID","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["MEDICAID ACO","80055 - CHG OBSTETRIC PANEL"]
["MEDICAID ACO","80076 - CHG HEPATIC FUNCTION PANEL"]
["MEDICAID ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MEDICAID ACO","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["MEDICAID LIMITED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["MEDICAID LIMITED","80069 - CHG RENAL FUNCTION PANEL"]
["MEDICAID LIMITED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["MEDICAID LIMITED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["MEDICAID LIMITED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["MEDICAID LIMITED","85610 - CHG PROTHROMBIN TIME"]
["MEDICAID MANAGED CARE","80055 - CHG OBSTETRIC PANEL"]
["MEDICAID MANAGED CARE","80076 - CHG HEPATIC FUNCTION PANEL"]
["MEDICAID MANAGED CARE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MEDICAID MANAGED CARE","85027 - CHG COMPLETE CBC"]
["MEDICARE","19120 - PR EXCISE BREAST CYST"]
["MEDICARE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["MEDICARE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["MEDICARE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["MEDICARE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["MEDICARE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["MEDICARE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["MEDICARE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["MEDICARE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["MEDICARE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["MEDICARE","80055 - CHG OBSTETRIC PANEL"]
["MEDICARE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["MEDICARE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["MEDICARE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["MEDICARE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["MEDICARE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["MEDICARE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["MEDICARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["MEDICARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["MEDICARE","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["MEDICARE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["MEDICARE","A9517 - PR I131 IODIDE CAP, RX"]
["MEDICARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["MEDICARE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["NEIGHBORHOOD PACE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["NEIGHBORHOOD PACE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["NEIGHBORHOOD PACE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["NEIGHBORHOOD PACE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["NEIGHBORHOOD PACE","70553 - CHG MRI BRAIN COMBO"]
["NEIGHBORHOOD PACE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["NEIGHBORHOOD PACE","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["NEIGHBORHOOD PACE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["NEIGHBORHOOD PACE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["NEIGHBORHOOD PACE","80061 - CHG LIPID PANEL"]
["NEIGHBORHOOD PACE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["NEIGHBORHOOD PACE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["NEIGHBORHOOD PACE","85027 - CHG COMPLETE CBC"]
["NEIGHBORHOOD PACE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["NEIGHBORHOOD PACE","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["NEIGHBORHOOD PACE","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["NEIGHBORHOOD PACE","90853 - PR GROUP PSYCHOTHERAPY"]
["NEIGHBORHOOD PACE","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["NEIGHBORHOOD PACE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["NEIGHBORHOOD PACE","A9500 - PR TC99M SESTAMIBI"]
["NEIGHBORHOOD PACE","A9552 - PR F18 FDG"]
["NEIGHBORHOOD PACE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["NEIGHBORHOOD PACE","A9581 - PR GADOXETATE DISODIUM INJ"]
["NEIGHBORHOOD PACE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["OXFORD HEALTH","19120 - PR EXCISE BREAST CYST"]
["OXFORD HEALTH","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["OXFORD HEALTH","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["OXFORD HEALTH","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["OXFORD HEALTH","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["OXFORD HEALTH","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["OXFORD HEALTH","72148 - CHG MRI, LUMBAR SPINE"]
["OXFORD HEALTH","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["OXFORD HEALTH","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["OXFORD HEALTH","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["OXFORD HEALTH","80055 - CHG OBSTETRIC PANEL"]
["OXFORD HEALTH","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["OXFORD HEALTH","84443 - CHG ASSAY THYROID STIM HORMONE"]
["OXFORD HEALTH","85610 - CHG PROTHROMBIN TIME"]
["OXFORD HEALTH","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["OXFORD HEALTH","90715 - PR TDAP VACCINE >7 YO, IM"]
["OXFORD HEALTH","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["OXFORD HEALTH","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["OXFORD HEALTH","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["OXFORD HEALTH","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["OXFORD HEALTH","A9500 - PR TC99M SESTAMIBI"]
["OXFORD HEALTH","A9517 - PR I131 IODIDE CAP, RX"]
["OXFORD HEALTH","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["OXFORD HEALTH","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["OXFORD HEALTH","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","19120 - PR EXCISE BREAST CYST"]
["SENIOR WHOLE HEALTH","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["SENIOR WHOLE HEALTH","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["SENIOR WHOLE HEALTH","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["SENIOR WHOLE HEALTH","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["SENIOR WHOLE HEALTH","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["SENIOR WHOLE HEALTH","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["SENIOR WHOLE HEALTH","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["SENIOR WHOLE HEALTH","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["SENIOR WHOLE HEALTH","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["SENIOR WHOLE HEALTH","80076 - CHG HEPATIC FUNCTION PANEL"]
["SENIOR WHOLE HEALTH","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["SENIOR WHOLE HEALTH","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["SENIOR WHOLE HEALTH","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["SENIOR WHOLE HEALTH","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["SENIOR WHOLE HEALTH","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["SENIOR WHOLE HEALTH","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["SENIOR WHOLE HEALTH","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["SENIOR WHOLE HEALTH","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["SENIOR WHOLE HEALTH","A9500 - PR TC99M SESTAMIBI"]
["SENIOR WHOLE HEALTH","A9513 - DELETED 2077"]
["SENIOR WHOLE HEALTH","A9555 - PR RB82 RUBIDIUM"]
["SENIOR WHOLE HEALTH","A9581 - PR GADOXETATE DISODIUM INJ"]
["SENIOR WHOLE HEALTH","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["SENIOR WHOLE HEALTH","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TRICARE EAST","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["TRICARE EAST","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["TRICARE EAST","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["TRICARE EAST","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["TRICARE EAST","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["TRICARE EAST","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["TRICARE EAST","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["TRICARE EAST","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["TRICARE EAST","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["TRICARE EAST","80069 - CHG RENAL FUNCTION PANEL"]
["TRICARE EAST","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["TRICARE EAST","84443 - CHG ASSAY THYROID STIM HORMONE"]
["TRICARE EAST","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["TRICARE EAST","90715 - PR TDAP VACCINE >7 YO, IM"]
["TRICARE EAST","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["TRICARE EAST","90853 - PR GROUP PSYCHOTHERAPY"]
["TRICARE EAST","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["TRICARE EAST","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["TRICARE EAST","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["TRICARE EAST","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["TRICARE EAST","A9513 - DELETED 2077"]
["TRICARE EAST","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["TRICARE EAST","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TRICARE EAST","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["TRICARE FOR LIFE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["TRICARE FOR LIFE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["TRICARE FOR LIFE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["TRICARE FOR LIFE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["TRICARE FOR LIFE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["TRICARE FOR LIFE","70553 - CHG MRI BRAIN COMBO"]
["TRICARE FOR LIFE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["TRICARE FOR LIFE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["TRICARE FOR LIFE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["TRICARE FOR LIFE","80055 - CHG OBSTETRIC PANEL"]
["TRICARE FOR LIFE","80061 - CHG LIPID PANEL"]
["TRICARE FOR LIFE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["TRICARE FOR LIFE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["TRICARE FOR LIFE","85027 - CHG COMPLETE CBC"]
["TRICARE FOR LIFE","90715 - PR TDAP VACCINE >7 YO, IM"]
["TRICARE FOR LIFE","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["TRICARE FOR LIFE","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["TRICARE FOR LIFE","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["TRICARE FOR LIFE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["TRICARE FOR LIFE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["TRICARE FOR LIFE","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["TRICARE FOR LIFE","A9552 - PR F18 FDG"]
["TRICARE FOR LIFE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["TRICARE FOR LIFE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TRICARE FOR LIFE","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["TUFTS","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["TUFTS","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["TUFTS","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["TUFTS","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["TUFTS","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["TUFTS","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["TUFTS","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["TUFTS","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["TUFTS","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["TUFTS","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["TUFTS","80061 - CHG LIPID PANEL"]
["TUFTS","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["TUFTS","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["TUFTS","85610 - CHG PROTHROMBIN TIME"]
["TUFTS","90715 - PR TDAP VACCINE >7 YO, IM"]
["TUFTS","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["TUFTS","90853 - PR GROUP PSYCHOTHERAPY"]
["TUFTS","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["TUFTS","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["TUFTS","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["TUFTS","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["TUFTS","A9513 - DELETED 2077"]
["TUFTS","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["TUFTS","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["TUFTS","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["TUFTS CONNCARE/QHP","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["TUFTS CONNCARE/QHP","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["TUFTS CONNCARE/QHP","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["TUFTS CONNCARE/QHP","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["TUFTS CONNCARE/QHP","70553 - CHG MRI BRAIN COMBO"]
["TUFTS CONNCARE/QHP","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["TUFTS CONNCARE/QHP","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["TUFTS CONNCARE/QHP","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["TUFTS CONNCARE/QHP","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["TUFTS CONNCARE/QHP","80061 - CHG LIPID PANEL"]
["TUFTS CONNCARE/QHP","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["TUFTS CONNCARE/QHP","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["TUFTS CONNCARE/QHP","85027 - CHG COMPLETE CBC"]
["TUFTS CONNCARE/QHP","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["TUFTS CONNCARE/QHP","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["TUFTS CONNCARE/QHP","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["TUFTS CONNCARE/QHP","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["TUFTS CONNCARE/QHP","97110 - PR THERAPEUTIC EXERCISES"]
["TUFTS CONNCARE/QHP","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["TUFTS CONNCARE/QHP","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["TUFTS CONNCARE/QHP","A9513 - DELETED 2077"]
["TUFTS CONNCARE/QHP","A9555 - PR RB82 RUBIDIUM"]
["TUFTS CONNCARE/QHP","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS CONNCARE/QHP","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["TUFTS CONNCARE/QHP","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["TUFTS MEDICARE","19120 - PR EXCISE BREAST CYST"]
["TUFTS MEDICARE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["TUFTS MEDICARE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["TUFTS MEDICARE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["TUFTS MEDICARE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["TUFTS MEDICARE","70553 - CHG MRI BRAIN COMBO"]
["TUFTS MEDICARE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["TUFTS MEDICARE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["TUFTS MEDICARE","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["TUFTS MEDICARE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["TUFTS MEDICARE","80076 - CHG HEPATIC FUNCTION PANEL"]
["TUFTS MEDICARE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["TUFTS MEDICARE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["TUFTS MEDICARE","85027 - CHG COMPLETE CBC"]
["TUFTS MEDICARE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["TUFTS MEDICARE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["TUFTS MEDICARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["TUFTS MEDICARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["TUFTS MEDICARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["TUFTS MEDICARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["TUFTS MEDICARE","A9513 - DELETED 2077"]
["TUFTS MEDICARE","A9517 - PR I131 IODIDE CAP, RX"]
["TUFTS MEDICARE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["TUFTS MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS MEDICARE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["TUFTS MEDICARE MANAGED","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["TUFTS MEDICARE MANAGED","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["TUFTS MEDICARE MANAGED","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["TUFTS MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["TUFTS MEDICARE MANAGED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["TUFTS MEDICARE MANAGED","70553 - CHG MRI BRAIN COMBO"]
["TUFTS MEDICARE MANAGED","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["TUFTS MEDICARE MANAGED","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["TUFTS MEDICARE MANAGED","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["TUFTS MEDICARE MANAGED","80055 - CHG OBSTETRIC PANEL"]
["TUFTS MEDICARE MANAGED","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["TUFTS MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["TUFTS MEDICARE MANAGED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["TUFTS MEDICARE MANAGED","85027 - CHG COMPLETE CBC"]
["TUFTS MEDICARE MANAGED","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["TUFTS MEDICARE MANAGED","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["TUFTS MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["TUFTS MEDICARE MANAGED","97110 - PR THERAPEUTIC EXERCISES"]
["TUFTS MEDICARE MANAGED","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["TUFTS MEDICARE MANAGED","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["TUFTS MEDICARE MANAGED","A9500 - PR TC99M SESTAMIBI"]
["TUFTS MEDICARE MANAGED","A9552 - PR F18 FDG"]
["TUFTS MEDICARE MANAGED","A9581 - PR GADOXETATE DISODIUM INJ"]
["TUFTS MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS TOGETHER ACO","80055 - CHG OBSTETRIC PANEL"]
["TUFTS TOGETHER ACO","80076 - CHG HEPATIC FUNCTION PANEL"]
["TUFTS TOGETHER ACO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["TUFTS TOGETHER ACO","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["TUFTS TOGETHER ACO","85610 - CHG PROTHROMBIN TIME"]
["TUFTS TOGETHER MCO","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["TUFTS TOGETHER MCO","80069 - CHG RENAL FUNCTION PANEL"]
["TUFTS TOGETHER MCO","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["TUFTS TOGETHER MCO","84443 - CHG ASSAY THYROID STIM HORMONE"]
["TUFTS TOGETHER MCO","85610 - CHG PROTHROMBIN TIME"]
["TUFTS TOGETHER MCO","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["UBH HPHC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["UBH HPHC","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["UBH HPHC","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["UBH HPHC","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["UBH HPHC","72148 - CHG MRI, LUMBAR SPINE"]
["UBH HPHC","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["UBH HPHC","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["UBH HPHC","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["UBH HPHC","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["UBH HPHC","80069 - CHG RENAL FUNCTION PANEL"]
["UBH HPHC","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["UBH HPHC","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["UBH HPHC","85610 - CHG PROTHROMBIN TIME"]
["UBH HPHC","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["UBH HPHC","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["UBH HPHC","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["UBH HPHC","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["UBH HPHC","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["UBH HPHC","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["UBH HPHC","A9500 - PR TC99M SESTAMIBI"]
["UBH HPHC","A9555 - PR RB82 RUBIDIUM"]
["UBH HPHC","A9581 - PR GADOXETATE DISODIUM INJ"]
["UBH HPHC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UBH HPHC","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["UNICARE","19120 - PR EXCISE BREAST CYST"]
["UNICARE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["UNICARE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["UNICARE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["UNICARE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["UNICARE","72148 - CHG MRI, LUMBAR SPINE"]
["UNICARE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["UNICARE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["UNICARE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["UNICARE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["UNICARE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["UNICARE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["UNICARE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["UNICARE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["UNICARE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["UNICARE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["UNICARE","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["UNICARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["UNICARE","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["UNICARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["UNICARE","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["UNICARE","A9552 - PR F18 FDG"]
["UNICARE","A9555 - PR RB82 RUBIDIUM"]
["UNICARE","A9581 - PR GADOXETATE DISODIUM INJ"]
["UNICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["UNITED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["UNITED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["UNITED","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["UNITED","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["UNITED","72148 - CHG MRI, LUMBAR SPINE"]
["UNITED","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["UNITED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["UNITED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["UNITED","80069 - CHG RENAL FUNCTION PANEL"]
["UNITED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["UNITED","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["UNITED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["UNITED","85610 - CHG PROTHROMBIN TIME"]
["UNITED","90715 - PR TDAP VACCINE >7 YO, IM"]
["UNITED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["UNITED","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["UNITED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["UNITED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["UNITED","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["UNITED","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["UNITED","A9517 - PR I131 IODIDE CAP, RX"]
["UNITED","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["UNITED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["UNITED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED COMMUNITY PLAN","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["UNITED COMMUNITY PLAN","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["UNITED COMMUNITY PLAN","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["UNITED COMMUNITY PLAN","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["UNITED COMMUNITY PLAN","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["UNITED COMMUNITY PLAN","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["UNITED COMMUNITY PLAN","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["UNITED COMMUNITY PLAN","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["UNITED COMMUNITY PLAN","80055 - CHG OBSTETRIC PANEL"]
["UNITED COMMUNITY PLAN","80076 - CHG HEPATIC FUNCTION PANEL"]
["UNITED COMMUNITY PLAN","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["UNITED COMMUNITY PLAN","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["UNITED COMMUNITY PLAN","85610 - CHG PROTHROMBIN TIME"]
["UNITED COMMUNITY PLAN","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["UNITED COMMUNITY PLAN","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["UNITED COMMUNITY PLAN","90853 - PR GROUP PSYCHOTHERAPY"]
["UNITED COMMUNITY PLAN","97110 - PR THERAPEUTIC EXERCISES"]
["UNITED COMMUNITY PLAN","99203 - PR OFFICE OUTPATIENT NEW 30-44 MINUTES"]
["UNITED COMMUNITY PLAN","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["UNITED COMMUNITY PLAN","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["UNITED COMMUNITY PLAN","A9555 - PR RB82 RUBIDIUM"]
["UNITED COMMUNITY PLAN","A9581 - PR GADOXETATE DISODIUM INJ"]
["UNITED COMMUNITY PLAN","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["UNITED COMMUNITY PLAN","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED MEDICARE MANAGED","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["UNITED MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["UNITED MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["UNITED MEDICARE MANAGED","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["UNITED MEDICARE MANAGED","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["UNITED MEDICARE MANAGED","72148 - CHG MRI, LUMBAR SPINE"]
["UNITED MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["UNITED MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["UNITED MEDICARE MANAGED","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["UNITED MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["UNITED MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["UNITED MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["UNITED MEDICARE MANAGED","84443 - CHG ASSAY THYROID STIM HORMONE"]
["UNITED MEDICARE MANAGED","85610 - CHG PROTHROMBIN TIME"]
["UNITED MEDICARE MANAGED","90715 - PR TDAP VACCINE >7 YO, IM"]
["UNITED MEDICARE MANAGED","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["UNITED MEDICARE MANAGED","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["UNITED MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["UNITED MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["UNITED MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["UNITED MEDICARE MANAGED","A9513 - DELETED 2077"]
["UNITED MEDICARE MANAGED","A9555 - PR RB82 RUBIDIUM"]
["UNITED MEDICARE MANAGED","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["UNITED MEDICARE MANAGED","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["UNITED MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UPHAMS CORNER ESP","19120 - PR EXCISE BREAST CYST"]
["UPHAMS CORNER ESP","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["UPHAMS CORNER ESP","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["UPHAMS CORNER ESP","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["UPHAMS CORNER ESP","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["UPHAMS CORNER ESP","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["UPHAMS CORNER ESP","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["UPHAMS CORNER ESP","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["UPHAMS CORNER ESP","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["UPHAMS CORNER ESP","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["UPHAMS CORNER ESP","80076 - CHG HEPATIC FUNCTION PANEL"]
["UPHAMS CORNER ESP","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["UPHAMS CORNER ESP","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["UPHAMS CORNER ESP","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["UPHAMS CORNER ESP","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["UPHAMS CORNER ESP","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["UPHAMS CORNER ESP","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["UPHAMS CORNER ESP","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["UPHAMS CORNER ESP","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["UPHAMS CORNER ESP","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["UPHAMS CORNER ESP","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["UPHAMS CORNER ESP","A9555 - PR RB82 RUBIDIUM"]
["UPHAMS CORNER ESP","A9581 - PR GADOXETATE DISODIUM INJ"]
["UPHAMS CORNER ESP","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["UPHAMS CORNER ESP","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["UPHAMS CORNER ESP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLCARE","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["WELLCARE","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["WELLCARE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["WELLCARE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["WELLCARE","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["WELLCARE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["WELLCARE","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["WELLCARE","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["WELLCARE","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["WELLCARE","80069 - CHG RENAL FUNCTION PANEL"]
["WELLCARE","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["WELLCARE","84443 - CHG ASSAY THYROID STIM HORMONE"]
["WELLCARE","85610 - CHG PROTHROMBIN TIME"]
["WELLCARE","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["WELLCARE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["WELLCARE","90853 - PR GROUP PSYCHOTHERAPY"]
["WELLCARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["WELLCARE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["WELLCARE","A9500 - PR TC99M SESTAMIBI"]
["WELLCARE","A9552 - PR F18 FDG"]
["WELLCARE","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["WELLCARE","A9581 - PR GADOXETATE DISODIUM INJ"]
["WELLCARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLCARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLSENSE","80055 - CHG OBSTETRIC PANEL"]
["WELLSENSE","80076 - CHG HEPATIC FUNCTION PANEL"]
["WELLSENSE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["WELLSENSE","85027 - CHG COMPLETE CBC"]
["WELLSENSE ALLI ACO","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["WELLSENSE ALLI ACO","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["WELLSENSE ALLI ACO","80069 - CHG RENAL FUNCTION PANEL"]
["WELLSENSE ALLI ACO","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["WELLSENSE ALLI ACO","84443 - CHG ASSAY THYROID STIM HORMONE"]
["WELLSENSE ALLI ACO","85610 - CHG PROTHROMBIN TIME"]
["WELLSENSE ESSENTIAL MCO","80055 - CHG OBSTETRIC PANEL"]
["WELLSENSE ESSENTIAL MCO","80076 - CHG HEPATIC FUNCTION PANEL"]
["WELLSENSE ESSENTIAL MCO","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["WELLSENSE ESSENTIAL MCO","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["WELLSENSE ESSENTIAL MCO","85027 - CHG COMPLETE CBC"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","70553 - CHG MRI BRAIN COMBO"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","80055 - CHG OBSTETRIC PANEL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","80076 - CHG HEPATIC FUNCTION PANEL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","85027 - CHG COMPLETE CBC"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9500 - PR TC99M SESTAMIBI"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9513 - DELETED 2077"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9555 - PR RB82 RUBIDIUM"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9581 - PR GADOXETATE DISODIUM INJ"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLSENSE MEDICARE MANAGED","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["WELLSENSE MEDICARE MANAGED","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["WELLSENSE MEDICARE MANAGED","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["WELLSENSE MEDICARE MANAGED","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["WELLSENSE MEDICARE MANAGED","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["WELLSENSE MEDICARE MANAGED","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["WELLSENSE MEDICARE MANAGED","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["WELLSENSE MEDICARE MANAGED","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["WELLSENSE MEDICARE MANAGED","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["WELLSENSE MEDICARE MANAGED","80069 - CHG RENAL FUNCTION PANEL"]
["WELLSENSE MEDICARE MANAGED","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["WELLSENSE MEDICARE MANAGED","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["WELLSENSE MEDICARE MANAGED","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["WELLSENSE MEDICARE MANAGED","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["WELLSENSE MEDICARE MANAGED","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["WELLSENSE MEDICARE MANAGED","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["WELLSENSE MEDICARE MANAGED","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["WELLSENSE MEDICARE MANAGED","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["WELLSENSE MEDICARE MANAGED","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["WELLSENSE MEDICARE MANAGED","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["WELLSENSE MEDICARE MANAGED","A9513 - DELETED 2077"]
["WELLSENSE MEDICARE MANAGED","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["WELLSENSE MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLSENSE MEDICARE MANAGED","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["WORKERS COMP","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["WORKERS COMP","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["WORKERS COMP","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["WORKERS COMP","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["WORKERS COMP","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["WORKERS COMP","70553 - CHG MRI BRAIN COMBO"]
["WORKERS COMP","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["WORKERS COMP","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["WORKERS COMP","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["WORKERS COMP","80055 - CHG OBSTETRIC PANEL"]
["WORKERS COMP","80061 - CHG LIPID PANEL"]
["WORKERS COMP","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["WORKERS COMP","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["WORKERS COMP","85027 - CHG COMPLETE CBC"]
["WORKERS COMP","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["WORKERS COMP","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["WORKERS COMP","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["WORKERS COMP","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["WORKERS COMP","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["WORKERS COMP","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["WORKERS COMP","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["WORKERS COMP","A9513 - DELETED 2077"]
["WORKERS COMP","A9555 - PR RB82 RUBIDIUM"]
["WORKERS COMP","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["WORKERS COMP","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["WORKERS COMP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZAETNA","19120 - PR EXCISE BREAST CYST"]
["ZZZAETNA","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZAETNA","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["ZZZAETNA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["ZZZAETNA","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["ZZZAETNA","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["ZZZAETNA","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["ZZZAETNA","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["ZZZAETNA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZAETNA","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZAETNA","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZAETNA","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZAETNA","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZAETNA","85027 - CHG COMPLETE CBC"]
["ZZZAETNA","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["ZZZAETNA","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["ZZZAETNA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZAETNA","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["ZZZAETNA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZAETNA","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["ZZZAETNA","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["ZZZAETNA","A9552 - PR F18 FDG"]
["ZZZAETNA","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ZZZAETNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZAETNA","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["ZZZAETNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZBU EMPLOYEE WORK COMP","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZBU EMPLOYEE WORK COMP","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["ZZZBU EMPLOYEE WORK COMP","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["ZZZBU EMPLOYEE WORK COMP","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZBU EMPLOYEE WORK COMP","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["ZZZBU EMPLOYEE WORK COMP","72148 - CHG MRI, LUMBAR SPINE"]
["ZZZBU EMPLOYEE WORK COMP","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["ZZZBU EMPLOYEE WORK COMP","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["ZZZBU EMPLOYEE WORK COMP","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZBU EMPLOYEE WORK COMP","80069 - CHG RENAL FUNCTION PANEL"]
["ZZZBU EMPLOYEE WORK COMP","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["ZZZBU EMPLOYEE WORK COMP","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZBU EMPLOYEE WORK COMP","85610 - CHG PROTHROMBIN TIME"]
["ZZZBU EMPLOYEE WORK COMP","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZBU EMPLOYEE WORK COMP","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZBU EMPLOYEE WORK COMP","90837 - PR PSYCHOTHERAPY W/PATIENT 60 MINUTES"]
["ZZZBU EMPLOYEE WORK COMP","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["ZZZBU EMPLOYEE WORK COMP","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["ZZZBU EMPLOYEE WORK COMP","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["ZZZBU EMPLOYEE WORK COMP","99386 - PR PREVENTIVE VISIT,NEW,40-64"]
["ZZZBU EMPLOYEE WORK COMP","A9517 - PR I131 IODIDE CAP, RX"]
["ZZZBU EMPLOYEE WORK COMP","A9552 - PR F18 FDG"]
["ZZZBU EMPLOYEE WORK COMP","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ZZZBU EMPLOYEE WORK COMP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZBU EMPLOYEE WORK COMP","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ZZZCCA ONECARE","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["ZZZCCA ONECARE","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["ZZZCCA ONECARE","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["ZZZCCA ONECARE","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZCCA ONECARE","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZCCA ONECARE","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["ZZZCCA ONECARE","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["ZZZCCA ONECARE","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["ZZZCCA ONECARE","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["ZZZCCA ONECARE","80061 - CHG LIPID PANEL"]
["ZZZCCA ONECARE","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["ZZZCCA ONECARE","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["ZZZCCA ONECARE","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["ZZZCCA ONECARE","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZCCA ONECARE","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["ZZZCCA ONECARE","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZCCA ONECARE","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["ZZZCCA ONECARE","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZCCA ONECARE","99214 - PR OFFICE OUTPATIENT VISIT 30-39 MINUTES"]
["ZZZCCA ONECARE","A9513 - DELETED 2077"]
["ZZZCCA ONECARE","A9517 - PR I131 IODIDE CAP, RX"]
["ZZZCCA ONECARE","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["ZZZCCA ONECARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCCA ONECARE","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["ZZZCIGNA","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["ZZZCIGNA","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["ZZZCIGNA","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["ZZZCIGNA","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["ZZZCIGNA","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["ZZZCIGNA","70553 - CHG MRI BRAIN COMBO"]
["ZZZCIGNA","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["ZZZCIGNA","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["ZZZCIGNA","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZCIGNA","80061 - CHG LIPID PANEL"]
["ZZZCIGNA","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["ZZZCIGNA","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["ZZZCIGNA","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["ZZZCIGNA","85027 - CHG COMPLETE CBC"]
["ZZZCIGNA","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["ZZZCIGNA","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
["ZZZCIGNA","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZCIGNA","97110 - PR THERAPEUTIC EXERCISES"]
["ZZZCIGNA","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZCIGNA","99213 - PR OFFICE OUTPATIENT VISIT 20-29 MINUTES"]
["ZZZCIGNA","99385 - PR PREVENTIVE VISIT,NEW,18-39"]
["ZZZCIGNA","A9513 - DELETED 2077"]
["ZZZCIGNA","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["ZZZCIGNA","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["ZZZCIGNA","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["ZZZCITY OF BOSTON WORK COMP","19120 - PR EXCISE BREAST CYST"]
["ZZZCITY OF BOSTON WORK COMP","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZCITY OF BOSTON WORK COMP","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["ZZZCITY OF BOSTON WORK COMP","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["ZZZCITY OF BOSTON WORK COMP","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZCITY OF BOSTON WORK COMP","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZCITY OF BOSTON WORK COMP","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["ZZZCITY OF BOSTON WORK COMP","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["ZZZCITY OF BOSTON WORK COMP","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZCITY OF BOSTON WORK COMP","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZCITY OF BOSTON WORK COMP","80055 - CHG OBSTETRIC PANEL"]
["ZZZCITY OF BOSTON WORK COMP","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZCITY OF BOSTON WORK COMP","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZCITY OF BOSTON WORK COMP","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["ZZZCITY OF BOSTON WORK COMP","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZCITY OF BOSTON WORK COMP","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["ZZZCITY OF BOSTON WORK COMP","90847 - PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS"]
["ZZZCITY OF BOSTON WORK COMP","95810 - PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND"]
["ZZZCITY OF BOSTON WORK COMP","97110 - PR THERAPEUTIC EXERCISES"]
["ZZZCITY OF BOSTON WORK COMP","99205 - PR OFFICE OUTPATIENT NEW 60-74 MINUTES"]
["ZZZCITY OF BOSTON WORK COMP","99215 - PR OFFICE OUTPATIENT VISIT 40-54 MINUTES"]
["ZZZCITY OF BOSTON WORK COMP","A9500 - PR TC99M SESTAMIBI"]
["ZZZCITY OF BOSTON WORK COMP","A9552 - PR F18 FDG"]
["ZZZCITY OF BOSTON WORK COMP","A9581 - PR GADOXETATE DISODIUM INJ"]
["ZZZCITY OF BOSTON WORK COMP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCITY OF BOSTON WORK COMP","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","19120 - PR EXCISE BREAST CYST"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","72148 - CHG MRI, LUMBAR SPINE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","80055 - CHG OBSTETRIC PANEL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","93452 - PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","99204 - PR OFFICE OUTPATIENT NEW 45-59 MINUTES"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","99212 - PR OFFICE OUTPATIENT VISIT 10-19 MINUTES"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9500 - PR TC99M SESTAMIBI"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9513 - DELETED 2077"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9517 - PR I131 IODIDE CAP, RX"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9552 - PR F18 FDG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9555 - PR RB82 RUBIDIUM"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9575 - PR INJ GADOTERATE MEGLUMI 0.1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9579 - GAD-BASE MR CONTRAST NOS,1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9581 - PR GADOXETATE DISODIUM INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1030 - PR METHYLPREDNISOLONE 40 MG INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9958 - PR HOCM <=149 MG/ML IODINE, 1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9963 - PR HOCM 350-399MG/ML IODINE,1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9966 - LOCM 200-299MG/ML IODINE,1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZHEALTH PLANS INC","19120 - PR EXCISE BREAST CYST"]
["ZZZHEALTH PLANS INC","29881 - PR KNEE SCOPE SINGLE MENISCECTOMY"]
["ZZZHEALTH PLANS INC","43235 - PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC"]
["ZZZHEALTH PLANS INC","43239 - PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE"]
["ZZZHEALTH PLANS INC","45378 - PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD"]
["ZZZHEALTH PLANS INC","45380 - PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE"]
["ZZZHEALTH PLANS INC","45385 - PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ"]
["ZZZHEALTH PLANS INC","45391 - PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX"]
["ZZZHEALTH PLANS INC","55700 - PR BIOPSY OF PROSTATE,NEEDLE/PUNCH"]
["ZZZHEALTH PLANS INC","62322 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN"]
["ZZZHEALTH PLANS INC","62323 - PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN"]
["ZZZHEALTH PLANS INC","64483 - PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL"]
["ZZZHEALTH PLANS INC","66821 - PR DISCISSION,2ND CATARACT,LASER"]
["ZZZHEALTH PLANS INC","66984 - PR REMV CATARACT EXTRACAP,INSERT LENS"]
["ZZZHEALTH PLANS INC","70450 - CHG CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL"]
["ZZZHEALTH PLANS INC","70553 - CHG MRI BRAIN COMBO"]
["ZZZHEALTH PLANS INC","72110 - CHG X-RAY LUMBAR SPINE 4 VW"]
["ZZZHEALTH PLANS INC","72148 - CHG MRI, LUMBAR SPINE"]
["ZZZHEALTH PLANS INC","72193 - CHG CT SCAN OF PELVIS CONTRAST"]
["ZZZHEALTH PLANS INC","73721 - CHG MRI LOWER EXTREM JT, W/O CONTRAST"]
["ZZZHEALTH PLANS INC","74177 - CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST"]
["ZZZHEALTH PLANS INC","76700 - CHG US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE"]
["ZZZHEALTH PLANS INC","76805 - CHG US, OB >/= 14 WKS, SNGL FETUS"]
["ZZZHEALTH PLANS INC","76830 - CHG ECHOGRAPHY,TRANSVAGINAL"]
["ZZZHEALTH PLANS INC","77065 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI"]
["ZZZHEALTH PLANS INC","77066 - CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI"]
["ZZZHEALTH PLANS INC","77067 - CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD"]
["ZZZHEALTH PLANS INC","80048 - CHG BASIC METABOLIC PANEL CALCIUM TOTAL"]
["ZZZHEALTH PLANS INC","80053 - CHG METABOLIC PANEL,COMPREHENSIVE"]
["ZZZHEALTH PLANS INC","80055 - CHG OBSTETRIC PANEL"]
["ZZZHEALTH PLANS INC","80061 - CHG LIPID PANEL"]
["ZZZHEALTH PLANS INC","80069 - CHG RENAL FUNCTION PANEL"]
["ZZZHEALTH PLANS INC","80076 - CHG HEPATIC FUNCTION PANEL"]
["ZZZHEALTH PLANS INC","81000 - CHG URINALYSIS, NONAUTO, W/SCOPE"]
["ZZZHEALTH PLANS INC","81001 - CHG URINALYSIS, AUTO, W/SCOPE"]
["ZZZHEALTH PLANS INC","81002 - CHG URINALYSIS NONAUTO W/O SCOPE"]
["ZZZHEALTH PLANS INC","81003 - CHG URINALYSIS, AUTO, W/O SCOPE"]
["ZZZHEALTH PLANS INC","84153 - CHG PROSTATE SPECIFIC ANTIGEN,TOTAL"]
["ZZZHEALTH PLANS INC","84443 - CHG ASSAY THYROID STIM HORMONE"]
["ZZZHEALTH PLANS INC","85025 - CHG COMPLETE CBC & AUTO DIFF WBC"]
["ZZZHEALTH PLANS INC","85027 - CHG COMPLETE CBC"]
["ZZZHEALTH PLANS INC","85610 - CHG PROTHROMBIN TIME"]
["ZZZHEALTH PLANS INC","85730 - CHG THROMBOPLAS TIME PARTIAL"]
["ZZZHEALTH PLANS INC","90662 - PR FLU VACCINE, INCREASED ANTIGEN, PRESV FREE"]
["ZZZHEALTH PLANS INC","90686 - PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE"]
["ZZZHEALTH PLANS INC","90715 - PR TDAP VACCINE >7 YO, IM"]
["ZZZHEALTH PLANS INC","90832 - PR PSYCHOTHERAPY W/PATIENT 30 MINUTES"]
["ZZZHEALTH PLANS INC","90834 - PR PSYCHOTHERAPY W/PATIENT 45 MINUTES"]
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["ZZZHEALTH PLANS INC","90846 - PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS"]
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{"sheet":"CPTCombo","index":18,"n_rows":83,"n_cols":16,"rows_kept":83,"cut":false,"hidden":true,"merged":[]}
[]
[]
[null,null,null,null,null,null,null,null,null,null,"CB Payer Link","Payer Content","CB Plan Link","Plan Content","CB BC Link","BC Content"]
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[null,null,null,null,null,null,null,null,null,1,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL",null,{"$f":"INDEX('CPTPayerPlan'!C29:BR29,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D29:BS29,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"MASS GENERAL BRIGHAM HEALTH PLAN MCD MNGED",null,{"$f":"INDEX('CPTPayerPlan'!C30:BR30,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D30:BS30,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME",null,{"$f":"INDEX('CPTPayerPlan'!C31:BR31,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D31:BS31,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"MEDICAID",null,{"$f":"INDEX('CPTPayerPlan'!C32:BR32,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D32:BS32,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"MEDICAID ACO",null,{"$f":"INDEX('CPTPayerPlan'!C33:BR33,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D33:BS33,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"MEDICAID LIMITED",null,{"$f":"INDEX('CPTPayerPlan'!C34:BR34,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D34:BS34,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"MEDICAID MANAGED CARE",null,{"$f":"INDEX('CPTPayerPlan'!C35:BR35,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D35:BS35,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"MEDICARE",null,{"$f":"INDEX('CPTPayerPlan'!C36:BR36,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D36:BS36,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"NEIGHBORHOOD PACE",null,{"$f":"INDEX('CPTPayerPlan'!C37:BR37,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D37:BS37,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"OXFORD HEALTH",null,{"$f":"INDEX('CPTPayerPlan'!C38:BR38,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D38:BS38,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"SENIOR WHOLE HEALTH",null,{"$f":"INDEX('CPTPayerPlan'!C39:BR39,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D39:BS39,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"TRICARE EAST",null,{"$f":"INDEX('CPTPayerPlan'!C40:BR40,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D40:BS40,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"TRICARE FOR LIFE",null,{"$f":"INDEX('CPTPayerPlan'!C41:BR41,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D41:BS41,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"TUFTS",null,{"$f":"INDEX('CPTPayerPlan'!C42:BR42,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D42:BS42,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"TUFTS CONNCARE/QHP",null,{"$f":"INDEX('CPTPayerPlan'!C43:BS43,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D43:BS43,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"TUFTS MEDICARE",null,{"$f":"INDEX('CPTPayerPlan'!C44:BS44,,$K$4)","v":0},null,{"$f":"INDEX('CPTPayer&Code&Desc'!D44:BS44,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"TUFTS MEDICARE MANAGED",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D45:BS45,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"TUFTS TOGETHER ACO",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D46:BS46,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"TUFTS TOGETHER MCO",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D47:BS47,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"UBH HPHC",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D48:BS48,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"UNICARE",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D49:BS49,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"UNITED",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D50:BS50,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"UNITED COMMUNITY PLAN",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D51:BS51,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"UNITED MEDICARE MANAGED",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D52:BS52,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"UPHAMS CORNER ESP",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D53:BS53,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"WELLCARE",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D54:BS54,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"WELLSENSE",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D55:BS55,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"WELLSENSE ALLI ACO",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D56:BS56,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"WELLSENSE ESSENTIAL MCO",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D57:BS57,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D58:BS58,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"WELLSENSE MEDICARE MANAGED",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D59:BS59,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"WORKERS COMP",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D60:BS60,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZAETNA",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D61:BS61,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZBU EMPLOYEE WORK COMP",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D62:BS62,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZCCA ONECARE",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D63:BS63,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZCIGNA",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D64:BS64,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZCITY OF BOSTON WORK COMP",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D65:BS65,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D66:BS66,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZHEALTH PLANS INC",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D67:BS67,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZRAILROAD MEDICARE",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D68:BS68,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,1,null,"ZZZUNITED",null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D69:BS69,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D70:BS70,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D71:BS71,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D72:BS72,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D73:BS73,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D74:BS74,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D75:BS75,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D76:BS76,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D77:BS77,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D78:BS78,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D79:BS79,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D80:BS80,,$K$4)","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"INDEX('CPTPayer&Code&Desc'!D81:BS81,,$K$4)","v":0}]

{"sheet":"HCPCS Table","index":19,"n_rows":72376,"n_cols":13,"rows_kept":2250,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
["Payer – Plan – Bill Type – Bill Code","Payer","Plan","Bill Type","Bill Code","Billing Description","Bill Code & Description","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge","Duplcates"]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - A9576","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - C9113","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - C9257","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0583","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0688","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0688","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,30.2,3.16,456.36,7.55,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0702","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,3.81,3.81,456.36,10.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,3.81,3.81,456.36,10.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",57.91,3.81,3.81,456.36,14.48,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",14.75,5.71,5.31,456.36,3.69,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",104.24,57.12,1.9,456.36,26.06,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",335.72,335.72,120.86,456.36,83.93,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",511.56,511.56,14.28,511.56,127.89,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,222.04,61.88,456.36,55.51,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.34,1.34,0.48,456.36,0.34,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",444.07,444.07,23.8,456.36,111.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1250","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,11.37,4.09,456.36,2.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,10.130000000000001,3.65,456.36,2.5299999999999998,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,35.5,2.78,456.36,8.8800000000000008,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,9.24,2.78,456.36,2.31,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,369.46,2.78,456.36,92.37,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",6.83,6.83,2.46,456.36,1.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1817","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",1.64,1.64,0.18,456.36,0.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.4700000000000002,2.4700000000000002,0.89,456.36,0.62,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2270","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2270","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2598","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2930","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3010","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3301","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",102.67,102.67,36.96,456.36,25.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7444.48,7444.48,420.34,7444.48,1861.12,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",124.59,124.59,14.95,456.36,31.15,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,7676.82,420.34,7676.82,1919.21,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.98,31.98,11.51,456.36,8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",3386.11,3386.11,420.34,3386.11,846.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",2.8,2.8,1.01,456.36,0.7,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3590","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,10.66,3.84,456.36,2.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",12.44,12.44,4.4800000000000004,456.36,3.11,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J8540","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - P9047","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",2163.34,710.85,420.34,1838.84,540.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",35,35,0.12,456.36,8.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,116,0.12,456.36,29,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - S0020","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - A9576","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - C9113","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - C9257","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0583","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0688","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0688","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,30.2,3.16,456.36,7.55,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0702","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",14.75,5.71,5.31,456.36,3.69,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",57.91,3.81,3.81,456.36,14.48,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",104.24,57.12,1.9,456.36,26.06,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,3.81,3.81,456.36,10.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,3.81,3.81,456.36,10.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,222.04,61.88,456.36,55.51,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.34,1.34,0.48,456.36,0.34,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",444.07,444.07,23.8,456.36,111.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",511.56,511.56,14.28,511.56,127.89,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",335.72,335.72,120.86,456.36,83.93,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1250","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",6.83,6.83,2.46,456.36,1.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,10.130000000000001,3.65,456.36,2.5299999999999998,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,35.5,2.78,456.36,8.8800000000000008,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,369.46,2.78,456.36,92.37,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,11.37,4.09,456.36,2.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,9.24,2.78,456.36,2.31,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1817","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.4700000000000002,2.4700000000000002,0.89,456.36,0.62,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",1.64,1.64,0.18,456.36,0.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2270","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2270","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2598","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
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["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
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["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
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["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2930","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3010","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3301","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",2.8,2.8,1.01,456.36,0.7,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7444.48,7444.48,420.34,7444.48,1861.12,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",124.59,124.59,14.95,456.36,31.15,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,7676.82,420.34,7676.82,1919.21,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",102.67,102.67,36.96,456.36,25.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.98,31.98,11.51,456.36,8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",3386.11,3386.11,420.34,3386.11,846.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3590","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,10.66,3.84,456.36,2.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",12.44,12.44,4.4800000000000004,456.36,3.11,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J8540","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - P9047","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",2163.34,710.85,420.34,1838.84,540.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,116,0.12,456.36,29,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",35,35,0.12,456.36,8.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - S0020","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - A9576","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - C9113","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - C9257","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0583","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0688","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0688","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,30.2,3.16,456.36,7.55,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0690","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0702","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",57.91,3.81,3.81,456.36,14.48,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,3.81,3.81,456.36,10.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",104.24,57.12,1.9,456.36,26.06,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,3.81,3.81,456.36,10.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",14.75,5.71,5.31,456.36,3.69,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,1.9,1.9,456.36,6.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",444.07,444.07,23.8,456.36,111.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.34,1.34,0.48,456.36,0.34,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",335.72,335.72,120.86,456.36,83.93,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,222.04,61.88,456.36,55.51,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",511.56,511.56,14.28,511.56,127.89,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1250","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,9.24,2.78,456.36,2.31,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",6.83,6.83,2.46,456.36,1.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,11.37,4.09,456.36,2.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,10.130000000000001,3.65,456.36,2.5299999999999998,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,35.5,2.78,456.36,8.8800000000000008,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1580","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,369.46,2.78,456.36,92.37,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1815","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1817","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1953","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",1.64,1.64,0.18,456.36,0.41,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.4700000000000002,2.4700000000000002,0.89,456.36,0.62,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2270","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2270","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2598","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2930","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3010","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3301","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",124.59,124.59,14.95,456.36,31.15,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",3386.11,3386.11,420.34,3386.11,846.53,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",102.67,102.67,36.96,456.36,25.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7444.48,7444.48,420.34,7444.48,1861.12,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",2.8,2.8,1.01,456.36,0.7,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.98,31.98,11.51,456.36,8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,7676.82,420.34,7676.82,1919.21,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3590","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,10.66,3.84,456.36,2.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7121","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",12.44,12.44,4.4800000000000004,456.36,3.11,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J8540","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - P9047","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q5114","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",2163.34,710.85,420.34,1838.84,540.84,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,116,0.12,456.36,29,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - Q9967","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",35,35,0.12,456.36,8.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - S0020","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - A9576","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - C9113","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - C9257","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0137","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1170","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1250","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2001","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2704","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J7131","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["AETNA - AETNA HMO - HCPCS - J0736","AETNA","AETNA HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,2.97,1.9,456.36,1.41,1]
["AETNA - AETNA HMO - HCPCS - J1953","AETNA","AETNA HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,56.38,7,456.36,26.65,1]
["AETNA - AETNA HMO - HCPCS - J2310","AETNA","AETNA HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,57.81,15.14,456.36,27.32,1]
["AETNA - AETNA HMO - HCPCS - J3490","AETNA","AETNA HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,16.73,11.38,456.36,7.91,1]
["AETNA - AETNA MCR SUPP - HCPCS - J0137","AETNA","AETNA MCR SUPP","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,22.55,5.0999999999999996,456.36,10.66,1]
["AETNA - AETNA MCR SUPP - HCPCS - J1170","AETNA","AETNA MCR SUPP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,22.55,15.35,456.36,10.66,1]
["AETNA - AETNA MCR SUPP - HCPCS - J2001","AETNA","AETNA MCR SUPP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.0699999999999998,1.41,456.36,0.98,1]
["AETNA - AETNA MCR SUPP - HCPCS - J2001","AETNA","AETNA MCR SUPP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.43,0.03,456.36,0.2,1]
["AETNA - AETNA MCR SUPP - HCPCS - J2704","AETNA","AETNA MCR SUPP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,40.6,13,456.36,19.190000000000001,1]
["AETNA - AETNA MCR SUPP - HCPCS - J3490","AETNA","AETNA MCR SUPP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,9.4,6.4,456.36,4.4400000000000004,1]
["AETNA - AETNA POS - HCPCS - J1170","AETNA","AETNA POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",335.72,177.6,120.86,456.36,83.93,1]
["AETNA - AETNA POS - HCPCS - J1815","AETNA","AETNA POS","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,22.26,4.55,456.36,10.52,1]
["AETNA - AETNA POS - HCPCS - J2001","AETNA","AETNA POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.43,0.03,456.36,0.2,1]
["AETNA - AETNA POS - HCPCS - J2704","AETNA","AETNA POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.29,0.88,456.36,0.61,1]
["AETNA - AETNA POS - HCPCS - J9041","AETNA","AETNA POS","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,1905.32,68.569999999999993,4840.46,1423.67,1]
["AETNA - AETNA PPO EPO - HCPCS - J0750","AETNA","AETNA PPO EPO","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,111.37,1.22,456.36,52.63,1]
["AETNA - AETNA PPO EPO - HCPCS - J1953","AETNA","AETNA PPO EPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,56.38,7,456.36,26.65,1]
["AETNA - AETNA PPO EPO - HCPCS - J2310","AETNA","AETNA PPO EPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,57.81,15.14,456.36,27.32,1]
["AETNA - AETNA PPO EPO - HCPCS - J2704","AETNA","AETNA PPO EPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,3.16,2.15,456.36,1.49,1]
["AETNA - AETNA PPO EPO - HCPCS - J3490","AETNA","AETNA PPO EPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,38.130000000000003,25.95,456.36,18.02,1]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J0688","AETNA","AETNA STUDENT HEALTH","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,6.87,4.32,456.36,3.25,1]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J1170","AETNA","AETNA STUDENT HEALTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,19.079999999999998,12.98,456.36,9.02,1]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2001","AETNA","AETNA STUDENT HEALTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.0699999999999998,1.41,456.36,0.98,1]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2704","AETNA","AETNA STUDENT HEALTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,3.87,2.6,456.36,1.83,1]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J3490","AETNA","AETNA STUDENT HEALTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",124.59,65.91,14.95,456.36,31.15,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0690","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J1815","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2270","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J3490","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["BCBS - BCBS HMO - HCPCS - J0583","BCBS","BCBS HMO","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61,1]
["BCBS - BCBS HMO - HCPCS - J0690","BCBS","BCBS HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["BCBS - BCBS HMO - HCPCS - J1561","BCBS","BCBS HMO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,488.8,417.75,7890.89,290.11,1]
["BCBS - BCBS HMO - HCPCS - J2001","BCBS","BCBS HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.84,1.03,456.36,0.71,1]
["BCBS - BCBS HMO - HCPCS - J2704","BCBS","BCBS HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["BCBS - BCBS HMO - HCPCS - J8540","BCBS","BCBS HMO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25,1]
["BCBS - BCBS INDEMNITY - HCPCS - J0736","BCBS","BCBS INDEMNITY","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,2.27,1.9,456.36,6.97,1]
["BCBS - BCBS INDEMNITY - HCPCS - J1815","BCBS","BCBS INDEMNITY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["BCBS - BCBS INDEMNITY - HCPCS - J2001","BCBS","BCBS INDEMNITY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.5299999999999998,1.41,456.36,0.98,1]
["BCBS - BCBS INDEMNITY - HCPCS - J2919","BCBS","BCBS INDEMNITY","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",80.260000000000005,80.260000000000005,28.89,456.36,20.07,1]
["BCBS - BCBS INDEMNITY - HCPCS - Q0249","BCBS","BCBS INDEMNITY","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,5.81,3.24,456.36,2.25,1]
["BCBS - BCBS POS - HCPCS - A9576","BCBS","BCBS POS","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25,1]
["BCBS - BCBS POS - HCPCS - J1170","BCBS","BCBS POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["BCBS - BCBS POS - HCPCS - J2001","BCBS","BCBS POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.5299999999999998,1.41,456.36,0.98,1]
["BCBS - BCBS POS - HCPCS - J2704","BCBS","BCBS POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["BCBS - BCBS POS - HCPCS - J3490","BCBS","BCBS POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["BCBS - BCBS PPO - HCPCS - J0690","BCBS","BCBS PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["BCBS - BCBS PPO - HCPCS - J1580","BCBS","BCBS PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",6.83,6.83,2.46,456.36,1.71,1]
["BCBS - BCBS PPO - HCPCS - J2001","BCBS","BCBS PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,14.19,7.91,456.36,5.49,1]
["BCBS - BCBS PPO - HCPCS - J2704","BCBS","BCBS PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["BCBS - BCBS PPO - HCPCS - J3490","BCBS","BCBS PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["BCBS - BCBS PPO - HCPCS - Q9967","BCBS","BCBS PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS - BCBS SHIP PPO - HCPCS - J0736","BCBS","BCBS SHIP PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,4.54,1.9,456.36,1.57,1]
["BCBS - BCBS SHIP PPO - HCPCS - J1815","BCBS","BCBS SHIP PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39,1]
["BCBS - BCBS SHIP PPO - HCPCS - J2270","BCBS","BCBS SHIP PPO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["BCBS - BCBS SHIP PPO - HCPCS - J3490","BCBS","BCBS SHIP PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,26.83,14.95,456.36,10.38,1]
["BCBS - BCBS SHIP PPO - HCPCS - Q9967","BCBS","BCBS SHIP PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,116,0.12,456.36,29,1]
["BCBS - BCBS STANDARD - HCPCS - J1170","BCBS","BCBS STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["BCBS - BCBS STANDARD - HCPCS - J1953","BCBS","BCBS STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["BCBS - BCBS STANDARD - HCPCS - J2001","BCBS","BCBS STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.5299999999999998,1.41,456.36,0.98,1]
["BCBS - BCBS STANDARD - HCPCS - J3490","BCBS","BCBS STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,56.32,31.39,456.36,21.8,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J0690","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J1580","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,369.46,2.78,456.36,92.37,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J1580","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2001","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.84,1.03,456.36,0.71,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2704","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J7131","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,10.26,5.72,456.36,3.97,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J0736","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J1953","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J2310","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J3490","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J0690","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J1817","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2001","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3490","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3490","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J0690","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J1561","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",232.09,97.76,83.55,456.36,58.02,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2001","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,14.19,7.91,456.36,5.49,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2704","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3590","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J0690","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1815","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1953","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J2919","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",3.69,3.69,1.33,456.36,0.92,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J9041","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,72.45,68.569999999999993,4840.46,1423.67,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - Q9967","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J1170","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J1953","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J2704","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J3490","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - Q9967","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J1561","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",2320.85,977.6,417.75,7890.89,580.21,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2001","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.84,1.03,456.36,0.71,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2704","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J3490","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J7131","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,10.26,5.72,456.36,3.97,1]
["CCA - CCA SCO ONECARE - HCPCS - J0736","CCA","CCA SCO ONECARE","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,2,1.9,456.36,6.97,1]
["CCA - CCA SCO ONECARE - HCPCS - J1953","CCA","CCA SCO ONECARE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["CCA - CCA SCO ONECARE - HCPCS - J2310","CCA","CCA SCO ONECARE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["CCA - CCA SCO ONECARE - HCPCS - J3490","CCA","CCA SCO ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["CCA - CCA SCO STANDARD - HCPCS - J0690","CCA","CCA SCO STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CCA - CCA SCO STANDARD - HCPCS - J1815","CCA","CCA SCO STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["CCA - CCA SCO STANDARD - HCPCS - J2001","CCA","CCA SCO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["CCA - CCA SCO STANDARD - HCPCS - J3490","CCA","CCA SCO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.98,31.98,11.51,456.36,8,1]
["CCA - CCA SCO STANDARD - HCPCS - Q9967","CCA","CCA SCO STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CCA - ZZZCCA STANDARD - HCPCS - J1170","CCA","ZZZCCA STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["CCA - ZZZCCA STANDARD - HCPCS - J1580","CCA","ZZZCCA STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["CCA - ZZZCCA STANDARD - HCPCS - J2001","CCA","ZZZCCA STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["CCA - ZZZCCA STANDARD - HCPCS - J2704","CCA","ZZZCCA STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CCA - ZZZCCA STANDARD - HCPCS - J7131","CCA","ZZZCCA STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J0736","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",14.75,6,5.31,456.36,3.69,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J1953","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J2704","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J3490","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - Q9967","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J1815","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2001","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J3490","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",3386.11,3386.11,420.34,3386.11,846.53,1]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J3490","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J0690","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J1580","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2001","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2704","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J9041","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67,1]
["CIGNA - CIGNA CARELINK - HCPCS - J1170","CIGNA","CIGNA CARELINK","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91,1]
["CIGNA - CIGNA CARELINK - HCPCS - J1953","CIGNA","CIGNA CARELINK","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["CIGNA - CIGNA CARELINK - HCPCS - J2704","CIGNA","CIGNA CARELINK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CIGNA - CIGNA CARELINK - HCPCS - J3490","CIGNA","CIGNA CARELINK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,22.47,17.75,456.36,12.33,1]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J0688","CIGNA","CIGNA LOCALPLUS","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,11.04,4.32,456.36,3.25,1]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J0736","CIGNA","CIGNA LOCALPLUS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",57.91,49.22,3.81,456.36,14.48,1]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J1580","CIGNA","CIGNA LOCALPLUS","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,1.86,0.79,456.36,0.55000000000000004,1]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2001","CIGNA","CIGNA LOCALPLUS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.22,0.03,456.36,7.0000000000000007E-2,1]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2704","CIGNA","CIGNA LOCALPLUS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.0699999999999998,0.88,456.36,0.61,1]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J3490","CIGNA","CIGNA LOCALPLUS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,26.88,11.38,456.36,7.91,1]
["CIGNA - CIGNA STANDARD - HCPCS - J0736","CIGNA","CIGNA STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,23.71,1.9,456.36,6.97,1]
["CIGNA - CIGNA STANDARD - HCPCS - J1815","CIGNA","CIGNA STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,172.64,73.12,456.36,50.78,1]
["CIGNA - CIGNA STANDARD - HCPCS - J2001","CIGNA","CIGNA STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.57999999999999996,0.06,456.36,0.17,1]
["CIGNA - CIGNA STANDARD - HCPCS - J2704","CIGNA","CIGNA STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,25.37,2.15,456.36,7.46,1]
["CIGNA - CIGNA STANDARD - HCPCS - Q5114","CIGNA","CIGNA STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,5223.6099999999997,420.34,5223.6099999999997,1536.36,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - C9257","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J1170","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,222.04,61.88,456.36,55.51,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2001","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2704","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J7121","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33,1]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J0736","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,2,1.9,456.36,1.41,1]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J1953","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2310","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J3490","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J0690","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J1580","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J1815","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2001","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J3490","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J0690","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J1170","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J2001","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J2704","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J7131","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J1170","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.34,1.34,0.48,456.36,0.34,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J1953","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2704","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2704","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J3490","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",124.59,124.59,14.95,456.36,31.15,1]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J0736","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,2,1.9,456.36,6.97,1]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J1953","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2001","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J3490","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J0690","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1580","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2001","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2704","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - Q9967","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1170","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1170","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2001","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2704","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J7131","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J0736","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",104.24,59.98,1.9,456.36,26.06,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J1953","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2598","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75,1]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J3490","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J0690","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,30.2,3.16,456.36,7.55,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1815","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2001","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2001","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",1.64,1.64,0.18,456.36,0.41,1]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J3490","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J0137","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.36,5.0999999999999996,456.36,10.66,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J1580","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2001","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2704","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J9041","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67,1]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J1170","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J1953","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2001","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2704","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J3490","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16,1]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J0690","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J1953","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2310","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J3490","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J0583","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J0690","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1580","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1953","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2001","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2001","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2310","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2704","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J3490","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - Q5114","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,2005.92,420.34,5223.6099999999997,1536.36,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J1170","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J1953","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2310","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J3490","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J0690","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J0736","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",104.24,59.98,1.9,456.36,26.06,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1580","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,10.130000000000001,3.65,456.36,2.5299999999999998,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1815","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1953","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2001","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2598","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2704","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J3490","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - Q9967","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J1170","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J1815","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2704","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J3490","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J3490","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J0736","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,2,1.9,456.36,6.97,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2310","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J1580","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,35.5,2.78,456.36,8.8800000000000008,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J3301","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75,1]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - Q9967","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1170","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1170","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J7131","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J0736","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",57.91,4,3.81,456.36,14.48,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J1580","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,35.5,2.78,456.36,8.8800000000000008,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1580","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.4700000000000002,2.4700000000000002,0.89,456.36,0.62,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - Q5114","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",2163.34,746.39,420.34,1838.84,540.84,1]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J1170","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",511.56,511.56,14.28,511.56,127.89,1]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J1580","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - C9113","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J1170","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J7131","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J1170","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1815","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2310","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J0688","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J1580","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J3010","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - Q5114","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,2005.92,420.34,5223.6099999999997,1536.36,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J1170","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J7121","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33,1]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J0736","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,4,3.81,456.36,10.53,1]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2310","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",0.47,0.47,0.17,456.36,0.12,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J1815","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - Q9967","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J1250","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J7131","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J0736","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,2,1.9,456.36,6.97,1]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J3010","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J1815","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J1580","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J9041","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J1170","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J0736","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,4,3.81,456.36,10.53,1]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J1953","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2310","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J0690","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J1815","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3490","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,7676.82,420.34,7676.82,1919.21,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J1170","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J1580","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2001","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2704","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J9041","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67,1]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J1170","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J1953","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2001","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3490","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0690","FALLON","FALLON COMMUNITY PLAN","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,6.5,4.32,456.36,3.25,1]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1580","FALLON","FALLON COMMUNITY PLAN","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,1.91,1.37,456.36,0.95,1]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2001","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,8,5.76,456.36,4,1]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2001","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.96,1.41,456.36,0.98,1]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2919","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",3.69,1.85,1.33,456.36,0.92,1]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J9041","FALLON","FALLON COMMUNITY PLAN","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2847.33,68.569999999999993,4840.46,1423.67,1]
["FALLON - FALLON HMO STANDARD - HCPCS - J0750","FALLON","FALLON HMO STANDARD","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,105.27,1.22,456.36,52.63,1]
["FALLON - FALLON HMO STANDARD - HCPCS - J1953","FALLON","FALLON HMO STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,53.29,7,456.36,26.65,1]
["FALLON - FALLON HMO STANDARD - HCPCS - J2704","FALLON","FALLON HMO STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,24.87,2.15,456.36,12.44,1]
["FALLON - FALLON HMO STANDARD - HCPCS - J3490","FALLON","FALLON HMO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,8.89,6.4,456.36,4.4400000000000004,1]
["FALLON - FALLON POS STANDARD - HCPCS - J0137","FALLON","FALLON POS STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,21.32,5.0999999999999996,456.36,10.66,1]
["FALLON - FALLON POS STANDARD - HCPCS - J1561","FALLON","FALLON POS STANDARD","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,2320.85,417.75,7890.89,1160.43,1]
["FALLON - FALLON POS STANDARD - HCPCS - J2001","FALLON","FALLON POS STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.34,0.06,456.36,0.17,1]
["FALLON - FALLON POS STANDARD - HCPCS - J2001","FALLON","FALLON POS STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.96,1.41,456.36,0.98,1]
["FALLON - FALLON POS STANDARD - HCPCS - J2704","FALLON","FALLON POS STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.22,0.88,456.36,0.61,1]
["FALLON - FALLON POS STANDARD - HCPCS - J3490","FALLON","FALLON POS STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,15.81,11.38,456.36,7.91,1]
["FALLON - FALLON PPO STANDARD - HCPCS - J0736","FALLON","FALLON PPO STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.14,1.9,456.36,1.57,1]
["FALLON - FALLON PPO STANDARD - HCPCS - J1815","FALLON","FALLON PPO STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,33.04,23.79,456.36,16.52,1]
["FALLON - FALLON PPO STANDARD - HCPCS - J2001","FALLON","FALLON PPO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.43,1.03,456.36,0.71,1]
["FALLON - FALLON PPO STANDARD - HCPCS - J2919","FALLON","FALLON PPO STANDARD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,6.54,4.71,456.36,3.27,1]
["FALLON - FALLON PPO STANDARD - HCPCS - J9041","FALLON","FALLON PPO STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2847.33,68.569999999999993,4840.46,1423.67,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1170","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1815","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2704","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3590","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J7121","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1170","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1953","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2310","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3490","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J0690","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J1815","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J2001","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J3490","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16,1]
["FALLON SCO - FALLON SCO HMO - HCPCS - J0690","FALLON SCO","FALLON SCO HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["FALLON SCO - FALLON SCO HMO - HCPCS - J1580","FALLON SCO","FALLON SCO HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2001","FALLON SCO","FALLON SCO HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2270","FALLON SCO","FALLON SCO HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2704","FALLON SCO","FALLON SCO HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["FALLON SCO - FALLON SCO HMO - HCPCS - Q5114","FALLON SCO","FALLON SCO HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1910.4,420.34,5223.6099999999997,1536.36,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J1170","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J1953","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J2919","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,6.57,4.71,456.36,3.27,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J1561","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,1991.6,417.75,7890.89,1160.43,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J1953","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J3490","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,36.04,25.95,456.36,18.02,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J3490","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",102.67,51.34,36.96,456.36,25.67,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J1815","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J8540","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J0736","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,5.62,1.9,456.36,1.41,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J1953","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0137","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.66,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J1170","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2001","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2001","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2919","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",4.97,2.5,1.79,456.36,1.24,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J1815","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2310","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J3490","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,15.81,11.38,456.36,7.91,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0736","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,42.1,3.81,456.36,10.53,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J1815","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J2704","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J9041","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1170","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,2.09,0.75,456.36,0.52,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1580","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,9.24,2.78,456.36,2.31,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1953","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2919","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,6.57,4.71,456.36,3.27,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J0690","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J1561","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,1991.6,420.34,3945.45,1160.43,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J2270","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J3301","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J0690","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J1561","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,497.9,417.75,7890.89,290.11,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J2704","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J7121","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55,1]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J7608","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.83,4.7699999999999996,456.36,3.31,1]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J1170","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J1953","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2704","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J3490","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["HSN - HSN STANDARD - HCPCS - J0690","HSN","HSN STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",0.47,456.36,0.17,456.36,0.12,1]
["HSN - HSN STANDARD - HCPCS - J1580","HSN","HSN STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,456.36,1.37,456.36,0.95,1]
["HSN - HSN STANDARD - HCPCS - J2001","HSN","HSN STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,456.36,1.41,456.36,0.98,1]
["HSN - HSN STANDARD - HCPCS - J2919","HSN","HSN STANDARD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,456.36,4.71,456.36,3.27,1]
["HSN - HSN STANDARD - HCPCS - Q5114","HSN","HSN STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,456.36,420.34,5223.6099999999997,1536.36,1]
["HSN - HSN TEMPORARY - HCPCS - J1170","HSN","HSN TEMPORARY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,456.36,0.75,456.36,0.52,1]
["HSN - HSN TEMPORARY - HCPCS - J1953","HSN","HSN TEMPORARY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,456.36,3.5,456.36,9.33,1]
["HSN - HSN TEMPORARY - HCPCS - J1953","HSN","HSN TEMPORARY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,456.36,3.5,456.36,9.33,1]
["HSN - HSN TEMPORARY - HCPCS - J2704","HSN","HSN TEMPORARY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,456.36,2.15,456.36,1.49,1]
["HSN - HSN TEMPORARY - HCPCS - J3490","HSN","HSN TEMPORARY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,456.36,106.43,456.36,73.91,1]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J0690","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,456.36,1.17,456.36,0.81,1]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J1561","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,456.36,420.34,3945.45,1160.43,1]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2001","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,456.36,1.41,456.36,0.98,1]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2704","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,456.36,2.15,456.36,1.49,1]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J3490","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,456.36,6.4,456.36,4.4400000000000004,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J0690","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,456.36,4.32,456.36,3.25,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J1170","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,456.36,0.7,456.36,0.49,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J1815","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,456.36,23.79,456.36,16.52,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2001","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,456.36,1.03,456.36,0.71,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2919","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,456.36,4.71,456.36,3.27,1]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - Q9967","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,456.36,0.12,456.36,0.25,1]
["HSN DENTAL - HSN DENTAL - HCPCS - J1170","HSN DENTAL","HSN DENTAL","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,456.36,12.98,456.36,9.02,1]
["HSN DENTAL - HSN DENTAL - HCPCS - J1953","HSN DENTAL","HSN DENTAL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,456.36,7,456.36,26.65,1]
["HSN DENTAL - HSN DENTAL - HCPCS - J2704","HSN DENTAL","HSN DENTAL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,456.36,0.88,456.36,0.61,1]
["HSN DENTAL - HSN DENTAL - HCPCS - J3490","HSN DENTAL","HSN DENTAL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,456.36,6.4,456.36,4.4400000000000004,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J0690","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,456.36,1.17,456.36,0.81,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1561","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",4641.7,456.36,420.34,3945.45,1160.43,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2001","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,456.36,1.41,456.36,0.98,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2001","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,456.36,1.03,456.36,0.71,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2704","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,456.36,2.6,456.36,1.83,1]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J3490","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,456.36,0.41,456.36,0.28000000000000003,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J0736","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,456.36,1.9,456.36,1.41,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1815","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,456.36,1.62,456.36,1.1299999999999999,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2001","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,456.36,0.03,456.36,0.2,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2919","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",18.510000000000002,456.36,6.66,456.36,4.63,1]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - Q5114","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,456.36,420.34,5223.6099999999997,1536.36,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J1170","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2001","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2704","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2704","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - A9576","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,2.82,1.58,456.36,1.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J0750","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,118.57,1.22,456.36,52.63,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J1953","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,21.01,3.5,456.36,9.33,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,9.01,5.76,456.36,4,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,10.01,6.4,456.36,4.4400000000000004,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - A9576","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,2.82,1.58,456.36,1.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J1170","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",511.56,288.11,14.28,511.56,127.89,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J1953","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,29.02,10.5,456.36,12.88,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.2000000000000002,1.41,456.36,0.98,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,49.11,31.39,456.36,21.8,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J0690","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,18.55,11.86,456.36,8.24,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J0690","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,7.32,4.32,456.36,3.25,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J1580","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,2.15,1.37,456.36,0.95,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.2000000000000002,1.41,456.36,0.98,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2919","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",3.69,2.08,1.33,456.36,0.92,1]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J7131","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,8.94,5.72,456.36,3.97,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J0736","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.53,1.9,456.36,1.57,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J1953","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,21.01,3.5,456.36,9.33,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2270","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,17.649999999999999,11.28,456.36,7.84,1]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,27.77,17.75,456.36,12.33,1]
["MEDICARE - MEDICARE A&B - HCPCS - J0131","MEDICARE","MEDICARE A&B","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["MEDICARE - MEDICARE A&B - HCPCS - J1170","MEDICARE","MEDICARE A&B","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["MEDICARE - MEDICARE A&B - HCPCS - J1580","MEDICARE","MEDICARE A&B","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["MEDICARE - MEDICARE A&B - HCPCS - J2310","MEDICARE","MEDICARE A&B","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["MEDICARE - MEDICARE A&B - HCPCS - J2704","MEDICARE","MEDICARE A&B","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["MEDICARE - MEDICARE A&B - HCPCS - Q9967","MEDICARE","MEDICARE A&B","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",35,35,0.12,456.36,8.75,1]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J1170","MEDICARE","MEDICARE PART A ONLY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.34,1.34,0.48,456.36,0.34,1]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2001","MEDICARE","MEDICARE PART A ONLY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2704","MEDICARE","MEDICARE PART A ONLY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3590","MEDICARE","MEDICARE PART A ONLY","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5,1]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J1170","MEDICARE","MEDICARE PART B ONLY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J1815","MEDICARE","MEDICARE PART B ONLY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78,1]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J2001","MEDICARE","MEDICARE PART B ONLY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J2704","MEDICARE","MEDICARE PART B ONLY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J3490","MEDICARE","MEDICARE PART B ONLY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J0736","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",14.75,5.71,5.31,456.36,3.69,1]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J1953","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2270","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J3490","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J0690","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,30.2,3.16,456.36,7.55,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J1815","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2001","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J3010","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J3490","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J0137","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J1580","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,369.46,2.78,456.36,92.37,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2001","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J3490","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J9041","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J1170","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J1953","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2704","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J3490","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J0690","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J0690","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2001","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2310","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J3490","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J0688","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1580","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2001","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2704","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - Q5114","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",2163.34,853.02,420.34,1838.84,540.84,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J0736","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,27.89,1.9,456.36,6.97,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2001","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2704","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2704","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J7131","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J0736","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",104.24,104.24,1.9,456.36,26.06,1]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J1953","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2310","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J3490","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J0690","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J1815","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J2001","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J3490","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,7676.82,420.34,7676.82,1919.21,1]
["TUFTS - TUFTS CARELINK - HCPCS - C9113","TUFTS","TUFTS CARELINK","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["TUFTS - TUFTS CARELINK - HCPCS - J0690","TUFTS","TUFTS CARELINK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,5.92,4.32,456.36,3.25,1]
["TUFTS - TUFTS CARELINK - HCPCS - J1250","TUFTS","TUFTS CARELINK","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.0999999999999996,3.24,456.36,2.25,1]
["TUFTS - TUFTS CARELINK - HCPCS - J2001","TUFTS","TUFTS CARELINK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["TUFTS - TUFTS CARELINK - HCPCS - J2704","TUFTS","TUFTS CARELINK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["TUFTS - TUFTS CARELINK - HCPCS - J3490","TUFTS","TUFTS CARELINK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["TUFTS - TUFTS HMO - HCPCS - J0690","TUFTS","TUFTS HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,5.92,4.32,456.36,3.25,1]
["TUFTS - TUFTS HMO - HCPCS - J1580","TUFTS","TUFTS HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["TUFTS - TUFTS HMO - HCPCS - J2001","TUFTS","TUFTS HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["TUFTS - TUFTS HMO - HCPCS - J2919","TUFTS","TUFTS HMO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",80.260000000000005,36.57,28.89,456.36,20.07,1]
["TUFTS - TUFTS HMO - HCPCS - J7307","TUFTS","TUFTS HMO","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1119.79,420.34,2688.55,790.75,1]
["TUFTS - TUFTS POS - HCPCS - A9576","TUFTS","TUFTS POS","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25,1]
["TUFTS - TUFTS POS - HCPCS - J1170","TUFTS","TUFTS POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["TUFTS - TUFTS POS - HCPCS - J1953","TUFTS","TUFTS POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["TUFTS - TUFTS POS - HCPCS - J2704","TUFTS","TUFTS POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["TUFTS - TUFTS POS - HCPCS - J3490","TUFTS","TUFTS POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,18.920000000000002,14.95,456.36,10.38,1]
["TUFTS - TUFTS PPO - HCPCS - J0137","TUFTS","TUFTS PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.66,1]
["TUFTS - TUFTS PPO - HCPCS - J1561","TUFTS","TUFTS PPO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",2320.85,974.97,420.34,1972.72,580.21,1]
["TUFTS - TUFTS PPO - HCPCS - J2001","TUFTS","TUFTS PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.78,1.41,456.36,0.98,1]
["TUFTS - TUFTS PPO - HCPCS - J2001","TUFTS","TUFTS PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.3,1.03,456.36,0.71,1]
["TUFTS - TUFTS PPO - HCPCS - J3490","TUFTS","TUFTS PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,22.47,17.75,456.36,12.33,1]
["TUFTS - TUFTS SELECT - HCPCS - J0690","TUFTS","TUFTS SELECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["TUFTS - TUFTS SELECT - HCPCS - J0702","TUFTS","TUFTS SELECT","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5,1]
["TUFTS - TUFTS SELECT - HCPCS - J1815","TUFTS","TUFTS SELECT","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78,1]
["TUFTS - TUFTS SELECT - HCPCS - J2001","TUFTS","TUFTS SELECT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["TUFTS - TUFTS SELECT - HCPCS - J2919","TUFTS","TUFTS SELECT","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",18.510000000000002,7.4,6.66,456.36,4.63,1]
["TUFTS - TUFTS SELECT - HCPCS - J9041","TUFTS","TUFTS SELECT","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,863.1,68.569999999999993,4840.46,1423.67,1]
["TUFTS - TUFTS SPIRIT - HCPCS - J0736","TUFTS","TUFTS SPIRIT","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41,1]
["TUFTS - TUFTS SPIRIT - HCPCS - J1953","TUFTS","TUFTS SPIRIT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["TUFTS - TUFTS SPIRIT - HCPCS - J2704","TUFTS","TUFTS SPIRIT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["TUFTS - TUFTS SPIRIT - HCPCS - J3490","TUFTS","TUFTS SPIRIT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J0690","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,420.34,1.17,456.36,0.81,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1815","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,420.34,4.55,456.36,3.16,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2001","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,420.34,0.06,456.36,0.17,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2001","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,420.34,0.03,456.36,7.0000000000000007E-2,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2930","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,420.34,24.44,456.36,20.07,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - Q9967","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,420.34,0.12,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J1170","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,420.34,0.23,456.36,0.16,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J1953","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,420.34,7,456.36,26.65,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,420.34,2.15,456.36,12.44,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3490","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,420.34,8.14,456.36,5.65,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J0690","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,420.34,1.17,456.36,0.81,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1561","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,420.34,417.75,7890.89,290.11,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1815","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,420.34,4.55,456.36,10.52,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,420.34,13,456.36,19.190000000000001,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,420.34,0.88,456.36,0.61,1]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J7131","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",12.44,420.34,4.4800000000000004,456.36,3.11,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J0736","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,2.64,1.9,456.36,6.97,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2310","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - Q9967","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",35,35,0.12,456.36,8.75,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J1580","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,420.34,2.78,456.36,2.31,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,420.34,1.03,456.36,0.71,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,420.34,13,456.36,19.190000000000001,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J7121","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,420.34,3.84,456.36,2.67,1]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J8540","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,420.34,0.09,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",444.07,444.07,23.8,456.36,111.02,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2310","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",30.2,420.34,3.16,456.36,7.55,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1580","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,420.34,2.78,456.36,8.8800000000000008,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,420.34,1.03,456.36,0.71,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2919","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,420.34,52.37,456.36,36.369999999999997,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J7131","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,420.34,5.72,456.36,3.97,1]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - Q5114","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,420.34,420.34,5223.6099999999997,1536.36,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,420.34,1.17,456.36,0.81,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1815","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,420.34,4.55,456.36,3.16,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,420.34,1.41,456.36,0.98,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,420.34,0.88,456.36,0.61,1]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - Q0249","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,420.34,3.24,456.36,2.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",444.07,444.07,23.8,456.36,111.02,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J7121","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,10.66,3.84,456.36,2.67,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0736","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",104.24,420.34,1.9,456.36,26.06,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1815","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,420.34,1.62,456.36,1.1299999999999999,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,420.34,7.91,456.36,5.49,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2919","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",4.97,420.34,1.79,456.36,1.24,1]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - Q9967","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,420.34,0.12,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.95,0.7,456.36,0.49,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - Q9967","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",1,1,0.12,456.36,0.25,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0736","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",14.75,420.34,5.31,456.36,3.69,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1817","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,420.34,24.27,456.36,16.86,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2310","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,420.34,1.73,456.36,1.2,1]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,420.34,11.38,456.36,7.91,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J0137","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1250","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2001","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2310","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J7131","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",12.44,12.44,4.4800000000000004,456.36,3.11,1]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - Q9967","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,116,0.12,456.36,29,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1170","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,36.06,12.98,456.36,9.02,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2001","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2704","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J3490","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J0736","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.81,1.9,456.36,1.57,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J1815","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J2310","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J3490","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J0690","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1815","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1815","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J2001","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J3490","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J0690","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J1580","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2001","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2704","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J9041","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J1170","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",32.299999999999997,32.299999999999997,9.52,456.36,8.08,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2001","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2001","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J3010","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J7121","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,10.66,3.84,456.36,2.67,1]
["UBH HPHC - UBH HPHC - HCPCS - J1170","UBH HPHC","UBH HPHC","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["UBH HPHC - UBH HPHC - HCPCS - J1953","UBH HPHC","UBH HPHC","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["UBH HPHC - UBH HPHC - HCPCS - J2598","UBH HPHC","UBH HPHC","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75,1]
["UBH HPHC - UBH HPHC - HCPCS - J3490","UBH HPHC","UBH HPHC","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["UNICARE - UNICARE STANDARD - HCPCS - J0690","UNICARE","UNICARE STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,15.8,11.86,456.36,8.24,1]
["UNICARE - UNICARE STANDARD - HCPCS - J1815","UNICARE","UNICARE STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",67.430000000000007,188,24.27,456.36,16.86,1]
["UNICARE - UNICARE STANDARD - HCPCS - J2001","UNICARE","UNICARE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.93,1.41,456.36,0.98,1]
["UNICARE - UNICARE STANDARD - HCPCS - J2704","UNICARE","UNICARE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,6.5,2.15,456.36,12.44,1]
["UNICARE - UNICARE STANDARD - HCPCS - J9041","UNICARE","UNICARE STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.400000000000006,68.569999999999993,4840.46,1423.67,1]
["UNICARE - UNICARE STANDARD - HCPCS - P9047","UNICARE","UNICARE STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.08,50.13,456.36,46.75,1]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1170","UNITED","UNITED DEFINITY HRA","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",16.52,16.52,5.95,456.36,4.13,1]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1953","UNITED","UNITED DEFINITY HRA","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["UNITED - UNITED DEFINITY HRA - HCPCS - J2704","UNITED","UNITED DEFINITY HRA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["UNITED - UNITED DEFINITY HRA - HCPCS - J3490","UNITED","UNITED DEFINITY HRA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["UNITED - UNITED HP SHIP - HCPCS - J0690","UNITED","UNITED HP SHIP","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["UNITED - UNITED HP SHIP - HCPCS - J1815","UNITED","UNITED HP SHIP","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["UNITED - UNITED HP SHIP - HCPCS - J2704","UNITED","UNITED HP SHIP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["UNITED - UNITED HP SHIP - HCPCS - J7307","UNITED","UNITED HP SHIP","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1114.33,420.34,2688.55,790.75,1]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1170","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",47,47,16.920000000000002,456.36,11.75,1]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1953","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1953","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J2704","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["UNITED - UNITED NAVIGATE - HCPCS - J0690","UNITED","UNITED NAVIGATE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2,1]
["UNITED - UNITED NAVIGATE - HCPCS - J1170","UNITED","UNITED NAVIGATE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,222.04,61.88,456.36,55.51,1]
["UNITED - UNITED NAVIGATE - HCPCS - J2001","UNITED","UNITED NAVIGATE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["UNITED - UNITED NAVIGATE - HCPCS - J2704","UNITED","UNITED NAVIGATE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["UNITED - UNITED NAVIGATE - HCPCS - J9041","UNITED","UNITED NAVIGATE","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J0750","UNITED","UNITED PASSPORT CONNECT","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,1.22,1.22,456.36,52.63,1]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J1953","UNITED","UNITED PASSPORT CONNECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J2704","UNITED","UNITED PASSPORT CONNECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J3490","UNITED","UNITED PASSPORT CONNECT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,15.81,11.38,456.36,7.91,1]
["UNITED - UNITED STANDARD - HCPCS - J0688","UNITED","UNITED STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25,1]
["UNITED - UNITED STANDARD - HCPCS - J1580","UNITED","UNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["UNITED - UNITED STANDARD - HCPCS - J2001","UNITED","UNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["UNITED - UNITED STANDARD - HCPCS - J2704","UNITED","UNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["UNITED - UNITED STANDARD - HCPCS - J8540","UNITED","UNITED STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25,1]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J1170","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,3.28,1.18,456.36,0.82,1]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J1953","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J2270","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J3490","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J0690","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J1817","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J1953","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J2310","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J3490","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J0690","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J1815","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J2001","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J3490","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - A9576","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J1580","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",6.83,6.83,2.46,456.36,1.71,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2001","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2001","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2704","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J0137","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J1170","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.34,1.34,0.48,456.36,0.34,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J2001","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J2704","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3590","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J0736","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,1.9,1.9,456.36,1.41,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J1953","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J2310","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J2704","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J0690","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,12.99,4.32,456.36,3.25,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J0690","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J1953","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J2001","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J3490","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J0690","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.3,1.17,456.36,0.81,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1561","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",232.09,92.84,83.55,456.36,58.02,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1953","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,14.92,3.5,456.36,9.33,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J2704","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,0.98,0.88,456.36,0.61,1]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J3490","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,0.64,0.57999999999999996,456.36,0.4,1]
["WELLCARE - WELLCARE HMO - HCPCS - J0690","WELLCARE","WELLCARE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["WELLCARE - WELLCARE HMO - HCPCS - J1815","WELLCARE","WELLCARE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29,1]
["WELLCARE - WELLCARE HMO - HCPCS - J2001","WELLCARE","WELLCARE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["WELLCARE - WELLCARE HMO - HCPCS - J2310","WELLCARE","WELLCARE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["WELLCARE - WELLCARE HMO - HCPCS - J3490","WELLCARE","WELLCARE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["WELLCARE - WELLCARE PPO - HCPCS - J0690","WELLCARE","WELLCARE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,20.79,3.16,456.36,5.2,1]
["WELLCARE - WELLCARE PPO - HCPCS - J1580","WELLCARE","WELLCARE PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,10.130000000000001,3.65,456.36,2.5299999999999998,1]
["WELLCARE - WELLCARE PPO - HCPCS - J2001","WELLCARE","WELLCARE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["WELLCARE - WELLCARE PPO - HCPCS - J2704","WELLCARE","WELLCARE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["WELLCARE - WELLCARE PPO - HCPCS - Q5114","WELLCARE","WELLCARE PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,1986.82,420.34,5223.6099999999997,1536.36,1]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1170","WELLCARE","WELLCARE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2001","WELLCARE","WELLCARE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2310","WELLCARE","WELLCARE STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2704","WELLCARE","WELLCARE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["WELLCARE - WELLCARE STANDARD - HCPCS - J7131","WELLCARE","WELLCARE STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J0736","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",5.62,2.02,1.9,456.36,1.41,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J1953","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,38.369999999999997,7,456.36,26.65,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2001","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,7.91,7.91,456.36,5.49,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2919","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,52.37,52.37,456.36,36.369999999999997,1]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - S0020","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.4900000000000002,2.4900000000000002,456.36,1.73,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J1170","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",42.63,42.63,15.35,456.36,10.66,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2001","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2704","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J7131","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J9041","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J1170","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",335.72,335.72,120.86,456.36,83.93,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2001","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2704","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J7131","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J0702","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,53.85,7.07,456.36,31.5,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1815","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,28.24,23.79,456.36,16.52,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J2001","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J2919","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,62.18,52.37,456.36,36.369999999999997,1]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J9041","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2433.9,68.569999999999993,4840.46,1423.67,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1170","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,94.9,61.88,456.36,55.51,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1170","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,15.41,12.98,456.36,9.02,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2001","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2704","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,2.5499999999999998,2.15,456.36,1.49,1]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J3490","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,328.52,198.58,768.65,192.16,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J0690","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,14.08,11.86,456.36,8.24,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1561","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,495.97,417.75,7890.89,290.11,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2001","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,9.39,7.91,456.36,5.49,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2704","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J3490","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,0.48,0.41,456.36,0.28000000000000003,1]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J0690","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,5.55,4.32,456.36,3.25,1]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1815","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,5.96,5.0199999999999996,456.36,3.49,1]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1815","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,17.98,4.55,456.36,10.52,1]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J2001","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98,1]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J2930","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,34.299999999999997,24.44,456.36,20.07,1]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - Q5114","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,2626.55,420.34,5223.6099999999997,1536.36,1]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1170","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,15.41,12.98,456.36,9.02,1]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1953","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,28.09,3.5,456.36,16.43,1]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J2704","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J3490","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,9.66,8.14,456.36,5.65,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J0690","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,8.89,3.16,456.36,5.2,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J1580","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",6.83,2.92,2.46,456.36,1.71,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2001","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,9.39,7.91,456.36,5.49,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2704","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2704","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,12.76,2.15,456.36,7.46,1]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J7121","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,6.07,5.12,456.36,3.55,1]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J0690","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,14.08,11.86,456.36,8.24,1]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J1815","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,5.4,4.55,456.36,3.16,1]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2001","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71,1]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J3490","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,13.51,11.38,456.36,7.91,1]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - Q9967","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",116,49.58,0.12,456.36,29,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1170","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.27,0.23,456.36,0.16,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1953","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,45.55,7,456.36,26.65,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2704","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,2.5499999999999998,2.15,456.36,1.49,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2704","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J3490","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,0.68,0.57999999999999996,456.36,0.4,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J0690","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.39,1.17,456.36,0.81,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1580","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,3.74,0.79,456.36,2.19,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J2001","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J2704","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J7131","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,6.79,5.72,456.36,3.97,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J0736","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,2.68,1.9,456.36,1.57,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1170","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",335.72,143.49,120.86,456.36,83.93,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J2001","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J2919","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,5.59,4.71,456.36,3.27,1]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J3490","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,13.51,11.38,456.36,7.91,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - A9576","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,2.14,1.58,456.36,1.25,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1170","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.34,0.56999999999999995,0.48,456.36,0.34,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1953","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,45.55,7,456.36,26.65,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J2704","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,21.26,2.15,456.36,12.44,1]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J3490","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,13.51,11.38,456.36,7.91,1]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J0690","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",20.79,8.89,3.16,456.36,5.2,1]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J1580","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,3.74,0.79,456.36,2.19,1]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2001","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.28999999999999998,0.06,456.36,0.17,1]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2704","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J7131","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,6.79,5.72,456.36,3.97,1]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J7131","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,6.79,5.72,456.36,3.97,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J0736","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,17.989999999999998,3.81,456.36,10.53,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1815","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,1.93,1.62,456.36,1.1299999999999999,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2270","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,13.39,11.28,456.36,7.84,1]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J3490","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,126.36,106.43,456.36,73.91,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J0131","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,18.22,5.0999999999999996,456.36,10.66,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J1170","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.27,0.23,456.36,0.16,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2001","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,9.39,7.91,456.36,5.49,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2704","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J3490","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.98,13.67,11.51,456.36,8,1]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J7121","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,4.5599999999999996,3.84,456.36,2.67,1]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J1580","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,4.8600000000000003,4.09,456.36,2.84,1]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J1815","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,17.98,4.55,456.36,10.52,1]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2001","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98,1]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2704","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J8540","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.43,0.09,456.36,0.25,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J0736","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",27.89,11.92,1.9,456.36,6.97,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J1815","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,28.24,23.79,456.36,16.52,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2001","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.22,1.03,456.36,0.71,1]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J3490","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,0.48,0.41,456.36,0.28000000000000003,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J0137","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,18.22,5.0999999999999996,456.36,10.66,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1170","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",3.28,1.4,1.18,456.36,0.82,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1953","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,45.55,7,456.36,26.65,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2001","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2704","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3490","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,7.59,6.4,456.36,4.4400000000000004,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0690","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,5.55,4.32,456.36,3.25,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J1580","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,3.74,0.79,456.36,2.19,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J2001","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.35,0.03,456.36,0.2,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J2704","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J7131","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,6.79,5.72,456.36,3.97,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J0750","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,89.98,1.22,456.36,52.63,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1953","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,45.55,7,456.36,26.65,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1953","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,15.95,3.5,456.36,9.33,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2310","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,46.71,15.14,456.36,27.32,1]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J3490","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,7.59,6.4,456.36,4.4400000000000004,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J0688","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,5.55,4.32,456.36,3.25,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J1170","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",36.06,15.41,12.98,456.36,9.02,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2001","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.28999999999999998,0.06,456.36,0.17,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2704","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J3490","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.98,13.67,11.51,456.36,8,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J0137","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,18.22,5.0999999999999996,456.36,10.66,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1580","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",6.83,2.92,2.46,456.36,1.71,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2001","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.28999999999999998,0.06,456.36,0.17,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2001","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2919","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",145.47999999999999,62.18,52.37,456.36,36.369999999999997,1]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - Q5114","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",6145.42,2626.55,420.34,5223.6099999999997,1536.36,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1170","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",2.09,0.89,0.75,456.36,0.52,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1953","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,15.95,3.5,456.36,9.33,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2310","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,46.71,15.14,456.36,27.32,1]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J3490","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,13.51,11.38,456.36,7.91,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J0137","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,18.22,5.0999999999999996,456.36,10.66,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J1561","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,495.97,417.75,7890.89,290.11,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2001","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.35,0.03,456.36,0.2,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2704","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2704","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,12.76,2.15,456.36,7.46,1]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J3490","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,328.52,198.58,768.65,192.16,1]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J0736","ZZZAETNA","ZZZAETNA HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",6.27,3.32,1.9,456.36,1.57,1]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J1815","ZZZAETNA","ZZZAETNA HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,7.38,5.0199999999999996,456.36,3.49,1]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J2001","ZZZAETNA","ZZZAETNA HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.43,0.03,456.36,0.2,1]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J2919","ZZZAETNA","ZZZAETNA HMO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,6.91,4.71,456.36,3.27,1]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J9041","ZZZAETNA","ZZZAETNA HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,1905.32,68.569999999999993,4840.46,1423.67,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J1170","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",222.04,117.46,61.88,456.36,55.51,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J1953","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,34.770000000000003,3.5,456.36,16.43,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2310","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,2.54,1.73,456.36,1.2,1]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2704","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,15.79,2.15,456.36,7.46,1]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J0137","ZZZAETNA","ZZZAETNA POS","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,22.55,5.0999999999999996,456.36,10.66,1]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J0690","ZZZAETNA","ZZZAETNA POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.72,1.17,456.36,0.81,1]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J1561","ZZZAETNA","ZZZAETNA POS","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,613.87,417.75,7890.89,290.11,1]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J2001","ZZZAETNA","ZZZAETNA POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,1.51,1.03,456.36,0.71,1]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J2704","ZZZAETNA","ZZZAETNA POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,26.31,2.15,456.36,12.44,1]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3490","ZZZAETNA","ZZZAETNA POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,11.96,8.14,456.36,5.65,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J0690","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,1.72,1.17,456.36,0.81,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1580","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,4.62,0.79,456.36,2.19,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2001","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,2.0699999999999998,1.41,456.36,0.98,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2919","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",4.97,2.63,1.79,456.36,1.24,1]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - P9047","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,98.92,50.13,456.36,46.75,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1170","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.33,0.23,456.36,0.16,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1170","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",1.95,1.03,0.7,456.36,0.49,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1953","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,19.739999999999998,3.5,456.36,9.33,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2704","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.29,0.88,456.36,0.61,1]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J3490","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",124.59,65.91,14.95,456.36,31.15,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J0690","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,14.08,11.86,456.36,8.24,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J1580","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,15.17,2.78,456.36,8.8800000000000008,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J2001","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.35,0.03,456.36,0.2,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J2704","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,2.5499999999999998,2.15,456.36,1.49,1]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J3490","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,37.270000000000003,31.39,456.36,21.8,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J0690","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J0736","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,4,3.81,456.36,10.53,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J1953","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2310","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J3490","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J0690","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J1580","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,35.5,2.78,456.36,8.8800000000000008,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J2001","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J2704","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - C9113","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,15.1,6.4,456.36,4.4400000000000004,1]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J0690","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,11.04,4.32,456.36,3.25,1]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J1953","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,90.59,7,456.36,26.65,1]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2001","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.57999999999999996,0.06,456.36,0.17,1]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2704","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,25.37,2.15,456.36,7.46,1]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J3490","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,26.88,11.38,456.36,7.91,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J0690","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.99,5.92,4.32,456.36,3.25,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1580","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2001","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2704","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J7131","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,7.23,5.72,456.36,3.97,1]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J0736","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,35.79,3.81,456.36,10.53,1]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1815","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,56.17,23.79,456.36,16.52,1]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2310","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.09,1.73,456.36,1.2,1]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J3490","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,41.91,17.75,456.36,12.33,1]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J3490","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,26.88,11.38,456.36,7.91,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J0137","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,18.22,5.0999999999999996,456.36,10.66,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J1561","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",1160.43,495.97,417.75,7890.89,290.11,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2001","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,1.67,1.41,456.36,0.98,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2704","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,1.04,0.88,456.36,0.61,1]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J3490","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,328.52,198.58,768.65,192.16,1]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J0690","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1815","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2001","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J3490","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J3490","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J0690","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1580","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J2001","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J3490","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,8.89,6.4,456.36,4.4400000000000004,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J0690","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J1580","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J2704","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J3010","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J1170","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J1953","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J2704","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J2704","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J0131","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,42.63,5.0999999999999996,456.36,10.66,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J1561","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",9283.4,3983.2,417.75,7890.89,2320.85,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J2001","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J2919","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",13.07,6.57,4.71,456.36,3.27,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J0690","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",32.94,32.94,11.86,456.36,8.24,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J1815","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J2001","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J3490","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J0137","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J0690","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J1580","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,9.24,2.78,456.36,2.31,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2001","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2704","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J9041","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67,1]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J1170","ZZZUNITED","ZZZUNITED HP SHIP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",0.63,0.63,0.23,456.36,0.16,1]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J1953","ZZZUNITED","ZZZUNITED HP SHIP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J2704","ZZZUNITED","ZZZUNITED HP SHIP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J0137","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.66,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J1170","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",35.65,35.65,4.76,456.36,8.91,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J1815","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J2001","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",1.64,1.64,0.18,456.36,0.41,1]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J3010","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J0690","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",3.25,3.25,1.17,456.36,0.81,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J1580","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J2598","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,150.99,36.299999999999997,456.36,37.75,1]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J3490","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,15.81,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J0736","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",42.1,3.81,3.81,456.36,10.53,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",6.83,6.83,2.46,456.36,1.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",9.24,9.24,2.78,456.36,2.31,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",369.46,369.46,2.78,456.36,92.37,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",35.5,35.5,2.78,456.36,8.8800000000000008,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",11.37,11.37,4.09,456.36,2.84,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",3.81,3.81,1.37,456.36,0.95,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",8.74,8.74,0.79,456.36,2.19,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",10.130000000000001,10.130000000000001,3.65,456.36,2.5299999999999998,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",2.19,2.19,0.79,456.36,0.55000000000000004,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1580","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",81.849999999999994,81.849999999999994,1.37,456.36,20.46,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.51,4.51,1.62,456.36,1.1299999999999999,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",12.63,12.63,4.55,456.36,3.16,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",42.07,42.07,4.55,456.36,10.52,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",49.56,49.56,17.84,456.36,12.39,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",57.17,57.17,20.58,456.36,14.29,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",66.08,66.08,23.79,456.36,16.52,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",4.9800000000000004,4.9800000000000004,1.79,456.36,1.25,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",13.95,13.95,5.0199999999999996,456.36,3.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1815","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",203.1,203.1,73.12,456.36,50.78,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1817","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",51.52,51.52,10.5,456.36,12.88,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",65.73,65.73,3.5,456.36,16.43,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",37.31,37.31,3.5,456.36,9.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",106.58,106.58,7,456.36,26.65,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.4700000000000002,2.4700000000000002,0.89,456.36,0.62,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.26,0.26,0.03,456.36,7.0000000000000007E-2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",1.64,1.64,0.18,456.36,0.41,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",15.99,15.99,5.76,456.36,4,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",21.96,21.96,7.91,456.36,5.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.68,0.68,0.06,456.36,0.17,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",0.81,0.81,0.03,456.36,0.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",3.91,3.91,1.41,456.36,0.98,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.85,2.85,1.03,456.36,0.71,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2270","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2270","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",109.28,109.28,15.14,456.36,27.32,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2310","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",4.8099999999999996,4.8099999999999996,1.73,456.36,1.2,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2598","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
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["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",49.74,49.74,2.15,456.36,12.44,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",7.32,7.32,2.6,456.36,1.83,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",29.85,29.85,2.15,456.36,7.46,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",76.739999999999995,76.739999999999995,13,456.36,19.190000000000001,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",5.97,5.97,2.15,456.36,1.49,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",2.44,2.44,0.88,456.36,0.61,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2930","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3010","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3301","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",2.8,2.8,1.01,456.36,0.7,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7444.48,7444.48,420.34,7444.48,1861.12,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",124.59,124.59,14.95,456.36,31.15,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",7676.82,7676.82,420.34,7676.82,1919.21,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",72.069999999999993,72.069999999999993,25.95,456.36,18.02,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",768.65,768.65,198.58,768.65,192.16,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",102.67,102.67,36.96,456.36,25.67,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",41.53,41.53,14.95,456.36,10.38,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.98,31.98,11.51,456.36,8,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",17.77,17.77,6.4,456.36,4.4400000000000004,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",87.19,87.19,31.39,456.36,21.8,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",295.64,295.64,106.43,456.36,73.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",22.6,22.6,8.14,456.36,5.65,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.6,1.6,0.57999999999999996,456.36,0.4,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",1.1299999999999999,1.1299999999999999,0.41,456.36,0.28000000000000003,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",3386.11,3386.11,420.34,3386.11,846.53,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",31.62,31.62,11.38,456.36,7.91,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",49.31,49.31,17.75,456.36,12.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3590","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7121","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",21.32,21.32,3.84,456.36,5.33,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7121","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",10.66,10.66,3.84,456.36,2.67,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7121","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",12.44,12.44,4.4800000000000004,456.36,3.11,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",15.88,15.88,5.72,456.36,3.97,1]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J7131","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64,1]
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[]
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["Payer - Plan - Bill Type - Bill Code","Sum of Duplcates","Average of Gross Charge Amount","Average of Payer Charge Amount","Min of Minimum Charge Amount","Max of Maximum Charge Amount","Average of Self-Pay Charge"]
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["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1953",54,62.176666666666641,62.176666666666641,3.5,456.36,15.54555555555555]
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["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J2001",51,4.1013725490196071,1.7537254901960793,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2001",51,4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470591]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2001",51,4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J2001",51,4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2001",51,4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2001",51,4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470587]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J2001",51,4.101372549019608,2.1713725490196079,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2001",51,4.101372549019608,3.4850980392156861,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2001",51,4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2001",51,4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2001",51,4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J2001",51,4.101372549019608,1.7537254901960793,0.03,456.36,1.0252941176470587]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
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["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
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["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470591]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470589]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
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["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2001",51,4.101372549019608,3.4850980392156852,0.03,456.36,1.0252941176470591]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
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["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2001",51,4.1013725490196062,1.753725490196079,0.03,456.36,1.0252941176470589]
["UBH HPHC - UBH HPHC - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J2001",51,4.1013725490196062,1.7537254901960784,0.03,456.36,1.0252941176470591]
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["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["UNITED - UNITED DEFINITY HRA - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
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["UNITED - UNITED NAVIGATE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
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["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2001",51,4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470589]
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["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2001",51,4.101372549019608,1.753725490196079,0.03,456.36,1.0252941176470591]
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["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2001",51,4.101372549019608,1.7537254901960784,0.03,456.36,1.0252941176470589]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2001",51,4.1013725490196071,1.753725490196079,0.03,456.36,1.0252941176470591]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2001",51,4.1013725490196062,2.1713725490196083,0.03,456.36,1.0252941176470589]
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["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2001",51,4.1013725490196071,2.1713725490196079,0.03,456.36,1.0252941176470589]
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["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J2001",51,4.101372549019608,1.753725490196079,0.03,456.36,1.0252941176470591]
["WELLCARE - WELLCARE HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470587]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WELLCARE - WELLCARE PPO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2001",51,4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470587]
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["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2001",51,4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2001",51,4.1013725490196071,1.4776470588235289,0.03,456.36,1.0252941176470591]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J2001",51,4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2001",51,4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2001",51,4.1013725490196071,456.3600000000003,0.03,456.36,1.0252941176470587]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["FALLON - FALLON PPO STANDARD - HCPCS - J2001",51,4.1013725490196062,2.0545098039215683,0.03,456.36,1.0252941176470585]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2001",51,4.1013725490196062,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS POS - HCPCS - J2001",51,4.1013725490196071,2.35,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["FALLON - FALLON HMO STANDARD - HCPCS - J2001",51,4.101372549019608,2.0545098039215688,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2001",51,4.1013725490196071,2.3109803921568632,0.03,456.36,1.0252941176470589]
["HSN - HSN STANDARD - HCPCS - J2001",51,4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2001",51,4.1013725490196071,2.3109803921568628,0.03,456.36,1.0252941176470587]
["HSN DENTAL - HSN DENTAL - HCPCS - J2001",51,4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470591]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["MEDICARE - MEDICARE A&B - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS CARELINK - HCPCS - J2001",51,4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470587]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS SELECT - HCPCS - J2001",51,4.101372549019608,2.1700000000000008,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2001",51,4.1013725490196062,2.0545098039215688,0.03,456.36,1.0252941176470587]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470594]
["FALLON - FALLON POS STANDARD - HCPCS - J2001",51,4.101372549019608,2.0545098039215679,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HSN - HSN TEMPORARY - HCPCS - J2001",51,4.1013725490196071,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2001",51,4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2001",51,4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2001",51,4.101372549019608,2.3109803921568628,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2001",51,4.101372549019608,2.3109803921568628,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470585]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS HMO - HCPCS - J2001",51,4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS PPO - HCPCS - J2001",51,4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS SPIRIT - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470585]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470587]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2001",51,4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
["CIGNA - CIGNA CARELINK - HCPCS - J2001",51,4.1013725490196062,2.35,0.03,456.36,1.0252941176470589]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J2001",51,4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CCA - ZZZCCA STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2001",51,4.101372549019608,2.9639215686274518,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CCA - CCA SCO ONECARE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["AETNA - AETNA HMO - HCPCS - J2001",51,4.1013725490196071,2.1713725490196074,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AETNA - AETNA MCR SUPP - HCPCS - J2001",51,4.1013725490196071,2.1713725490196087,0.03,456.36,1.0252941176470591]
["CIGNA - CIGNA STANDARD - HCPCS - J2001",51,4.101372549019608,3.4850980392156847,0.03,456.36,1.0252941176470591]
["AETNA - AETNA POS - HCPCS - J2001",51,4.101372549019608,2.1713725490196083,0.03,456.36,1.0252941176470591]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["AETNA - AETNA PPO EPO - HCPCS - J2001",51,4.1013725490196062,2.171372549019607,0.03,456.36,1.0252941176470587]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2001",51,4.1013725490196071,2.1713725490196079,0.03,456.36,1.0252941176470587]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J2001",51,4.101372549019608,2.9639215686274518,0.03,456.36,1.0252941176470589]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2001",51,4.1013725490196071,2.9639215686274527,0.03,456.36,1.0252941176470594]
["BCBS - BCBS HMO - HCPCS - J2001",51,4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CCA - CCA SCO STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["BCBS - BCBS INDEMNITY - HCPCS - J2001",51,4.1013725490196062,2.9639215686274527,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS POS - HCPCS - J2001",51,4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS PPO - HCPCS - J2001",51,4.1013725490196071,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2001",51,4.101372549019608,3.4850980392156838,0.03,456.36,1.0252941176470585]
["BCBS - BCBS SHIP PPO - HCPCS - J2001",51,4.1013725490196062,2.9639215686274532,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS STANDARD - HCPCS - J2001",51,4.101372549019608,2.9639215686274527,0.03,456.36,1.0252941176470587]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2001",51,4.101372549019608,2.9639215686274527,0.03,456.36,1.0252941176470589]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J3490",47,454.52787234042535,386.34808510638294,0.41,7676.82,113.63319148936164]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3490",47,454.52787234042546,240.44595744680842,0.41,7676.82,113.63319148936164]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J3490",47,454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936161]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J3490",47,454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936164]
["UNITED - UNITED DEFINITY HRA - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936166]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3490",47,454.52787234042557,240.44595744680848,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J3490",47,454.52787234042557,194.26404255319147,0.41,7676.82,113.63319148936165]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J3490",47,454.52787234042557,240.44595744680842,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3490",47,454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936164]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J3490",47,454.52787234042557,386.348085106383,0.41,7676.82,113.63319148936169]
["UNITED - UNITED NAVIGATE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J3490",47,454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936171]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3490",47,454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J3490",47,454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J3490",47,454.52787234042557,194.26404255319156,0.41,7676.82,113.63319148936169]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J3490",47,454.52787234042523,240.44595744680842,0.41,7676.82,113.63319148936159]
["UNITED - UNITED STANDARD - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J3490",47,454.5278723404254,240.44595744680845,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J3490",47,454.52787234042523,194.26404255319147,0.41,7676.82,113.63319148936159]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J3490",47,454.5278723404254,194.26404255319153,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J3490",47,454.52787234042563,194.26404255319147,0.41,7676.82,113.63319148936171]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J3490",47,454.52787234042546,301.41787234042562,0.41,7676.82,113.63319148936169]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J3490",47,454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936169]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936166]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936169]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J3490",47,454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936171]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J3490",47,454.52787234042563,194.26404255319153,0.41,7676.82,113.63319148936171]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J3490",47,454.5278723404254,181.81170212765952,0.41,7676.82,113.63319148936161]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936165]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J3490",47,454.52787234042535,194.26404255319153,0.41,7676.82,113.63319148936161]
["WELLCARE - WELLCARE HMO - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936164]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J3490",47,454.52787234042535,194.26404255319156,0.41,7676.82,113.63319148936165]
["WELLCARE - WELLCARE PPO - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936165]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J3490",47,454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J3490",47,454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936164]
["WELLCARE - WELLCARE STANDARD - HCPCS - J3490",47,454.52787234042569,454.52787234042569,0.41,7676.82,113.63319148936169]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J3490",47,454.52787234042546,163.63042553191491,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3490",47,454.5278723404254,420.34000000000009,0.41,7676.82,113.63319148936159]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J3490",47,454.52787234042557,420.34000000000009,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3490",47,454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936166]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936159]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3490",47,454.52787234042563,420.34000000000009,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J3490",47,454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936169]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J3490",47,454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936165]
["UNICARE - UNICARE STANDARD - HCPCS - J3490",47,454.5278723404254,340.89723404255318,0.41,7676.82,113.63319148936164]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936165]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J3490",47,454.52787234042546,194.26404255319147,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J3490",47,454.52787234042546,194.26404255319147,0.41,7676.82,113.63319148936169]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3490",47,454.52787234042546,227.26680851063824,0.41,7676.82,113.63319148936164]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936159]
["FALLON - FALLON PPO STANDARD - HCPCS - J3490",47,454.52787234042546,227.26680851063824,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936172]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J3490",47,454.52787234042523,420.34000000000009,0.41,7676.82,113.63319148936164]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936172]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["FALLON - FALLON HMO STANDARD - HCPCS - J3490",47,454.5278723404254,227.26680851063824,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936166]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["FALLON SCO - FALLON SCO HMO - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936165]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["HSN - HSN STANDARD - HCPCS - J3490",47,454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936171]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936165]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936175]
["FALLON - FALLON POS STANDARD - HCPCS - J3490",47,454.52787234042523,227.26680851063821,0.41,7676.82,113.63319148936169]
["HSN - HSN TEMPORARY - HCPCS - J3490",47,454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936171]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J3490",47,454.52787234042563,255.99127659574469,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J3490",47,454.52787234042569,456.3600000000003,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936165]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J3490",47,454.5278723404254,456.3600000000003,0.41,7676.82,113.63319148936166]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936164]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936165]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["HSN DENTAL - HSN DENTAL - HCPCS - J3490",47,454.5278723404254,456.3600000000003,0.41,7676.82,113.63319148936166]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936171]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J3490",47,454.52787234042563,456.3600000000003,0.41,7676.82,113.63319148936171]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J3490",47,454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936165]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS CARELINK - HCPCS - J3490",47,454.5278723404254,298.5776595744681,0.41,7676.82,113.63319148936165]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS HMO - HCPCS - J3490",47,454.52787234042557,298.29744680851064,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS POS - HCPCS - J3490",47,454.5278723404254,298.29744680851076,0.41,7676.82,113.63319148936165]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J3490",47,454.52787234042557,255.99127659574481,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS PPO - HCPCS - J3490",47,454.52787234042557,298.57765957446804,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TUFTS - TUFTS SELECT - HCPCS - J3490",47,454.52787234042523,283.46468085106397,0.41,7676.82,113.63319148936164]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J3490",47,454.52787234042535,255.99127659574458,0.41,7676.82,113.63319148936161]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J3490",47,454.52787234042535,255.99127659574461,0.41,7676.82,113.63319148936156]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3490",47,454.52787234042557,420.34000000000009,0.41,7676.82,113.63319148936171]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J3490",47,454.52787234042557,240.44595744680845,0.41,7676.82,113.63319148936169]
["AETNA - AETNA PPO EPO - HCPCS - J3490",47,454.52787234042557,240.44595744680842,0.41,7676.82,113.63319148936166]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936172]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
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["AETNA - AETNA MCR SUPP - HCPCS - J3490",47,454.52787234042546,240.44595744680845,0.41,7676.82,113.63319148936165]
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["CCA - ZZZCCA STANDARD - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
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["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222275]
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["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J2704",45,17.345111111111127,7.4124444444444446,0.88,456.36,4.3362222222222249]
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["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["MEDICARE - MEDICARE A&B - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J3490",45,471.94533333333351,471.94533333333351,0.41,7676.82,117.98755555555557]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222222]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["TUFTS - TUFTS PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2704",45,17.34511111111112,456.36000000000024,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2704",45,17.345111111111123,456.36000000000024,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2704",45,17.345111111111127,9.7657777777777817,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222275]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2704",45,17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222222]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2704",45,17.345111111111123,8.6742222222222285,0.88,456.36,4.3362222222222249]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["FALLON - FALLON HMO STANDARD - HCPCS - J2704",45,17.345111111111127,8.6742222222222285,0.88,456.36,4.3362222222222258]
["TUFTS - TUFTS HMO - HCPCS - J2704",45,17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222222]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS SELECT - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["FALLON - FALLON POS STANDARD - HCPCS - J2704",45,17.34511111111112,8.6742222222222249,0.88,456.36,4.3362222222222231]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2704",45,17.345111111111127,456.36000000000024,0.88,456.36,4.336222222222224]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2704",45,17.345111111111127,420.34000000000009,0.88,456.36,4.3362222222222258]
["HSN DENTAL - HSN DENTAL - HCPCS - J2704",45,17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222258]
["FALLON - FALLON PPO STANDARD - HCPCS - J2704",45,17.345111111111127,8.6742222222222285,0.88,456.36,4.336222222222224]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2704",45,17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222249]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2704",45,17.34511111111112,9.7657777777777799,0.88,456.36,4.3362222222222231]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2704",45,17.345111111111123,9.7657777777777817,0.88,456.36,4.3362222222222231]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2704",45,17.345111111111127,9.7657777777777817,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MEDICARE - MEDICARE A&B - HCPCS - J3490",45,471.94533333333345,471.94533333333345,0.41,7676.82,117.98755555555557]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3490",45,471.94533333333345,471.94533333333345,0.41,7676.82,117.98755555555555]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J3490",45,471.94533333333317,471.94533333333317,0.41,7676.82,117.98755555555555]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222222]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222266]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222258]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J2704",45,17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222266]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS POS - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HSN - HSN STANDARD - HCPCS - J2704",45,17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS SPIRIT - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222222]
["HSN - HSN TEMPORARY - HCPCS - J2704",45,17.34511111111113,456.36000000000024,0.88,456.36,4.3362222222222249]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2704",45,17.34511111111112,420.34000000000009,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222258]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CCA - CCA SCO STANDARD - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["BCBS - BCBS POS - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CIGNA - CIGNA CARELINK - HCPCS - J2704",45,17.345111111111137,17.345111111111137,0.88,456.36,4.3362222222222275]
["BCBS - BCBS PPO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["BCBS - BCBS INDEMNITY - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["AETNA - AETNA HMO - HCPCS - J2704",45,17.34511111111112,9.175333333333338,0.88,456.36,4.336222222222224]
["CCA - ZZZCCA STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS - BCBS SHIP PPO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS - BCBS STANDARD - HCPCS - J2704",45,17.345111111111137,17.345111111111137,0.88,456.36,4.3362222222222275]
["CIGNA - CIGNA STANDARD - HCPCS - J2704",45,17.345111111111127,14.740444444444458,0.88,456.36,4.3362222222222258]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["AETNA - AETNA MCR SUPP - HCPCS - J2704",45,17.34511111111113,9.1753333333333398,0.88,456.36,4.3362222222222258]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2704",45,17.34511111111112,9.1753333333333345,0.88,456.36,4.3362222222222213]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222275]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2704",45,17.34511111111112,14.740444444444446,0.88,456.36,4.3362222222222231]
["AETNA - AETNA POS - HCPCS - J2704",45,17.345111111111123,9.175333333333338,0.88,456.36,4.336222222222224]
["BCBS - BCBS HMO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["AETNA - AETNA PPO EPO - HCPCS - J2704",45,17.345111111111127,9.1753333333333398,0.88,456.36,4.3362222222222249]
["CCA - CCA SCO ONECARE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1815",32,41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1815",32,41.60625000000001,41.60625000000001,1.62,456.36,10.403750000000002]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1580",32,40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999997]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1580",32,40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999998]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J0690",31,12.164516129032259,5.1999999999999993,0.17,456.36,3.0412903225806467]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J0690",31,12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806454]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J0690",31,12.164516129032259,420.34000000000009,0.17,456.36,3.0412903225806462]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0690",31,12.164516129032259,5.1999999999999975,0.17,456.36,3.0412903225806462]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J0690",31,12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0690",31,12.164516129032258,420.34000000000009,0.17,456.36,3.0412903225806462]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0690",31,12.164516129032259,420.34000000000009,0.17,456.36,3.0412903225806458]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J0690",31,12.164516129032259,5.1999999999999975,0.17,456.36,3.0412903225806462]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J0690",31,12.164516129032261,12.164516129032261,0.17,456.36,3.0412903225806462]
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["WELLCARE - WELLCARE STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J1170",27,71.055925925925919,25.580370370370375,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J1170",27,71.055925925925933,30.369259259259259,0.23,511.56,17.765555555555554]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J1953",27,62.176666666666648,22.383333333333333,3.5,456.36,15.545555555555556]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
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["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J1170",27,71.055925925925948,30.369259259259255,0.23,511.56,17.765555555555558]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J1170",27,71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J1170",27,71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148148]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J0690",27,12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148148]
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["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.54555555555555]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J1170",27,71.055925925925933,30.369259259259252,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148148]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1953",27,62.176666666666648,420.34000000000009,3.5,456.36,15.545555555555552]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1170",27,71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555551]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J1170",27,71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555552]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1170",27,71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J1953",27,62.176666666666655,26.574444444444453,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1953",27,62.176666666666669,26.574444444444438,3.5,456.36,15.545555555555554]
["UNITED - UNITED NAVIGATE - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J1953",27,62.176666666666655,32.891111111111115,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1170",27,71.055925925925948,30.369259259259248,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1953",27,62.176666666666669,26.574444444444445,3.5,456.36,15.545555555555556]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J1953",27,62.176666666666648,32.891111111111115,3.5,456.36,15.54555555555555]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J1953",27,62.176666666666641,32.891111111111115,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555551]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1953",27,62.176666666666669,26.574444444444445,3.5,456.36,15.545555555555556]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1953",27,62.176666666666655,32.891111111111115,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1170",27,71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1170",27,71.055925925925919,37.589259259259265,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1953",27,62.176666666666655,26.574444444444438,3.5,456.36,15.545555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J0690",27,12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555556]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J1170",27,71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555554]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J1953",27,62.176666666666648,26.574444444444445,3.5,456.36,15.545555555555554]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J1170",27,71.055925925925919,60.39925925925926,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J1170",27,71.055925925925948,30.369259259259266,0.23,511.56,17.765555555555562]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1170",27,71.055925925925933,64.286666666666676,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555552]
["UBH HPHC - UBH HPHC - HCPCS - J0690",27,11.837407407407408,11.837407407407408,0.17,456.36,2.9596296296296294]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1953",27,62.176666666666655,52.847777777777772,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1170",27,71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555554]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J1953",27,62.176666666666655,26.574444444444449,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1953",27,62.176666666666648,26.574444444444438,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1170",27,71.055925925925919,420.34000000000009,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1170",27,71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555558]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555556]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1953",27,62.176666666666648,26.574444444444435,3.5,456.36,15.545555555555556]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["UNICARE - UNICARE STANDARD - HCPCS - J1170",27,71.055925925925933,36.827777777777769,0.23,511.56,17.765555555555558]
["UNICARE - UNICARE STANDARD - HCPCS - J1953",27,62.176666666666648,5.833333333333333,3.5,456.36,15.545555555555554]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J0690",27,11.837407407407408,11.837407407407408,0.17,456.36,2.9596296296296307]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1170",27,71.055925925925919,420.34000000000009,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1953",27,62.176666666666641,26.574444444444438,3.5,456.36,15.545555555555552]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1170",27,71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555554]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1953",27,62.176666666666648,26.574444444444435,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["HSN - HSN STANDARD - HCPCS - J1170",27,71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555558]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J1953",27,62.176666666666655,456.36000000000013,3.5,456.36,15.545555555555552]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1170",27,71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["TUFTS - TUFTS SELECT - HCPCS - J1170",27,71.055925925925919,63.595555555555563,0.23,511.56,17.765555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS - TUFTS CARELINK - HCPCS - J1170",27,71.055925925925919,64.286666666666662,0.23,511.56,17.765555555555554]
["HSN DENTAL - HSN DENTAL - HCPCS - J1170",27,71.055925925925933,456.36000000000013,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["HSN DENTAL - HSN DENTAL - HCPCS - J1953",27,62.176666666666648,456.36000000000013,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J1170",27,71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555562]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555556]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["FALLON - FALLON HMO STANDARD - HCPCS - J1170",27,71.055925925925919,35.53037037037037,0.23,511.56,17.765555555555554]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1170",27,71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1953",27,62.176666666666648,456.36000000000013,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["TUFTS - TUFTS POS - HCPCS - J1170",27,71.055925925925919,64.286666666666662,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
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["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1170",27,71.055925925925919,35.53037037037037,0.23,511.56,17.765555555555554]
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["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
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["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
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["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["TUFTS - TUFTS HMO - HCPCS - J1170",27,71.055925925925933,64.286666666666676,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555556]
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["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["FALLON SCO - FALLON SCO HMO - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555551]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
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["FALLON - FALLON POS STANDARD - HCPCS - J1953",27,62.176666666666669,31.091111111111108,3.5,456.36,15.545555555555554]
["TUFTS - TUFTS PPO - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
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["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
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["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
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["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J1170",27,71.055925925925933,60.399259259259267,0.23,511.56,17.765555555555558]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
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["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CIGNA - CIGNA CARELINK - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
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["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1170",26,72.546538461538461,72.546538461538461,0.23,511.56,18.138076923076923]
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["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J1170",26,60.876538461538459,60.876538461538459,0.23,511.56,15.220769230769232]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J3490",22,370.19727272727272,185.10045454545454,1.01,7444.48,92.551363636363689]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J3490",22,370.19727272727272,185.10045454545454,1.01,7444.48,92.551363636363632]
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["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J2001",19,2.3747368421052637,2.3747368421052637,0.03,456.36,0.59315789473684188]
["UNITED - UNITED HP SHIP - HCPCS - J2001",19,2.3747368421052641,2.3747368421052641,0.03,456.36,0.59315789473684177]
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["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1815",16,41.606250000000003,17.781874999999996,1.62,456.36,10.403749999999999]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
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["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1580",16,40.208125000000003,17.186250000000001,0.79,456.36,10.052500000000002]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1580",16,40.208124999999995,17.186250000000001,0.79,456.36,10.0525]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1580",16,40.208125000000003,17.186249999999998,0.79,456.36,10.0525]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.052500000000002]
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["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J1580",16,40.208124999999995,22.645624999999999,0.79,456.36,10.052499999999998]
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["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
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["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1815",16,41.606249999999996,456.3599999999999,1.62,456.36,10.403749999999999]
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["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J1815",16,41.60625000000001,41.60625000000001,1.62,456.36,10.403750000000002]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J7131",16,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
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["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
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["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1580",16,40.208124999999988,40.208124999999988,0.79,456.36,10.052499999999998]
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["BCBS - BCBS HMO - HCPCS - J1815",16,41.606250000000003,38.462500000000006,1.62,456.36,10.403749999999999]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J1815",16,41.606249999999996,41.606249999999996,1.62,456.36,10.40375]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J1815",16,41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
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["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J1815",16,41.606250000000003,38.462500000000006,1.62,456.36,10.403750000000002]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J2919",13,48.286923076923067,24.287692307692314,1.33,456.36,12.073076923076922]
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["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2919",13,48.286923076923067,17.383846153846154,1.33,456.36,12.07307692307692]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2919",13,48.286923076923081,420.34000000000009,1.33,456.36,12.073076923076924]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J2919",13,48.286923076923081,20.639230769230771,1.33,456.36,12.073076923076922]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2919",13,48.286923076923081,20.639230769230771,1.33,456.36,12.07307692307692]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2919",13,48.286923076923081,41.043846153846161,1.33,456.36,12.07307692307692]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2919",13,48.286923076923088,20.639230769230771,1.33,456.36,12.073076923076927]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2919",13,48.286923076923067,456.35999999999996,1.33,456.36,12.073076923076922]
["FALLON - FALLON HMO STANDARD - HCPCS - J2919",13,48.286923076923095,24.146923076923084,1.33,456.36,12.073076923076924]
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["AETNA - AETNA PPO EPO - HCPCS - J2919",13,48.286923076923067,25.542307692307688,1.33,456.36,12.073076923076922]
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["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J0736",12,30.712499999999995,7.615000000000002,1.9,456.36,7.6799999999999988]
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["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0736",12,30.712499999999991,30.712499999999991,1.9,456.36,7.6799999999999988]
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["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J0736",12,30.712500000000006,7.9983333333333322,1.9,456.36,7.68]
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["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J0736",12,30.712499999999995,30.712499999999995,1.9,456.36,7.6799999999999988]
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["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2310",11,42.799090909090914,18.296363636363637,1.73,456.36,10.698181818181817]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2310",11,42.799090909090907,420.34000000000009,1.73,456.36,10.698181818181819]
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["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181819]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
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["CIGNA - CIGNA STANDARD - HCPCS - J2310",11,42.799090909090907,36.380909090909086,1.73,456.36,10.698181818181819]
["BCBS - BCBS PPO - HCPCS - J2310",11,42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
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["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J0137",6,42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
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["TUFTS - TUFTS SELECT - HCPCS - J0137",6,42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0137",6,42.63,21.319999999999997,5.0999999999999996,456.36,10.659999999999998]
["FALLON - FALLON PPO STANDARD - HCPCS - J0137",6,42.63,21.319999999999997,5.0999999999999996,456.36,10.659999999999998]
["TUFTS - TUFTS HMO - HCPCS - J0137",6,42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["AETNA - AETNA HMO - HCPCS - J0137",6,42.63,22.55,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - Q9967",6,25.833333333333332,11.043333333333331,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - Q9967",6,25.833333333333332,11.043333333333337,0.12,456.36,6.458333333333333]
["WELLCARE - WELLCARE STANDARD - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - Q9967",6,25.833333333333332,11.043333333333337,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - Q9967",6,25.833333333333332,11.043333333333335,0.12,456.36,6.458333333333333]
["UNITED - UNITED NAVIGATE - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - Q9967",6,25.833333333333332,21.958333333333329,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - Q9967",6,25.833333333333332,11.043333333333335,0.12,456.36,6.458333333333333]
["WELLCARE - WELLCARE PPO - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["UNICARE - UNICARE STANDARD - HCPCS - Q9967",6,25.833333333333332,0.12,0.12,456.36,6.458333333333333]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J0137",6,42.63,7,5.0999999999999996,456.36,10.659999999999998]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["AETNA - AETNA STUDENT HEALTH - HCPCS - Q9967",6,25.833333333333332,13.666666666666666,0.12,456.36,6.458333333333333]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["HSN - HSN TEMPORARY - HCPCS - Q9967",6,25.833333333333332,456.36000000000007,0.12,456.36,6.458333333333333]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CIGNA - CIGNA LOCALPLUS - HCPCS - Q9967",6,25.833333333333332,21.958333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["HSN - HSN STANDARD - HCPCS - Q9967",6,25.833333333333332,456.36000000000007,0.12,456.36,6.458333333333333]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - Q9967",6,25.833333333333332,14.546666666666667,0.12,456.36,6.458333333333333]
["MEDICARE - MEDICARE A&B - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["TUFTS - TUFTS CARELINK - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - Q9967",6,25.833333333333332,420.34,0.12,456.36,6.458333333333333]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - Q9967",6,25.833333333333332,420.34,0.12,456.36,6.458333333333333]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - Q9967",6,25.833333333333332,420.34,0.12,456.36,6.458333333333333]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J9041",5,5694.66,3012.48,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["UNITED - UNITED DEFINITY HRA - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J9041",5,5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J9041",5,5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J9041",5,5694.66,1905.3200000000002,68.569999999999993,4840.46,1423.67]
["WELLCARE - WELLCARE HMO - HCPCS - J9041",5,5694.66,71.31,68.569999999999993,4840.46,1423.67]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J9041",5,5694.66,420.34,68.569999999999993,4840.46,1423.67]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J9041",5,5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J9041",5,5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J9041",5,5694.66,456.36,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J9041",5,5694.66,3207.23,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J9041",5,5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J9041",5,5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J9041",5,5694.66,3207.23,68.569999999999993,4840.46,1423.67]
["TUFTS - TUFTS SELECT - HCPCS - J9041",5,5694.66,863.1,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J9041",5,5694.66,4840.46,68.569999999999993,4840.46,1423.67]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["BCBS - BCBS POS - HCPCS - J9041",5,5694.66,72.45,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - Q5114",4,5149.8999999999996,2454.9250000000002,420.34,5223.6099999999997,1287.48]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - Q5114",4,5149.8999999999996,2230.0825,420.34,5223.6099999999997,1287.4799999999998]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - Q5114",4,5149.8999999999996,1610.5874999999999,420.34,5223.6099999999997,1287.4799999999998]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - Q5114",4,5149.8999999999996,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - Q5114",4,5149.8999999999996,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - Q5114",4,5149.8999999999996,2201.0650000000005,420.34,5223.6099999999997,1287.4799999999998]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - Q5114",4,5149.8999999999996,1610.5874999999999,420.34,5223.6099999999997,1287.4799999999998]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - Q5114",4,5149.9000000000005,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - Q5114",4,5149.9000000000005,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["UNITED - UNITED STANDARD - HCPCS - Q5114",4,5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - Q5114",4,5149.9000000000005,1610.5875000000001,420.34,5223.6099999999997,1287.48]
["UNITED - UNITED NAVIGATE - HCPCS - Q5114",4,5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["WELLCARE - WELLCARE PPO - HCPCS - Q5114",4,5149.8999999999996,1674.9349999999999,420.34,5223.6099999999997,1287.4799999999998]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - Q5114",4,5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - Q5114",4,5149.9000000000005,1610.5875000000001,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - Q5114",4,5149.9000000000005,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - Q5114",4,5149.9000000000005,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - Q5114",4,5149.8999999999996,1467.0375000000001,420.34,5223.6099999999997,1287.48]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - Q5114",4,5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - Q5114",4,5149.8999999999996,420.34,420.34,5223.6099999999997,1287.48]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - Q5114",4,5149.9000000000005,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - Q5114",4,5149.8999999999996,1610.5874999999999,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - Q5114",4,5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["TUFTS - TUFTS SELECT - HCPCS - Q5114",4,5149.8999999999996,1642.8500000000001,420.34,5223.6099999999997,1287.4799999999998]
["FALLON - FALLON HMO STANDARD - HCPCS - Q5114",4,5149.8999999999996,2574.9499999999998,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J0688",4,12.99,12.99,4.32,456.36,3.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - Q5114",4,5149.9000000000005,2900.4224999999997,420.34,5223.6099999999997,1287.48]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - Q5114",4,5149.9000000000005,2269.9749999999999,420.34,5223.6099999999997,1287.48]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - Q5114",4,5149.9000000000005,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - Q5114",4,5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["CCA - CCA SCO STANDARD - HCPCS - Q5114",4,5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - Q5114",4,5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - Q5114",4,5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J0750",3,210.53,1.22,1.22,456.36,52.63]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J7121",3,15.396666666666667,420.34,3.84,456.36,3.85]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J0750",3,210.53,1.22,1.22,456.36,52.63]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J0750",3,210.53,89.98,1.22,456.36,52.63]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J0750",3,210.53,89.98,1.22,456.36,52.63]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.85]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J0750",3,210.53,89.98,1.22,456.36,52.63]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.8499999999999996]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.85]
["WELLCARE - WELLCARE HMO - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J0750",3,210.53,89.98,1.22,456.36,52.63]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.8499999999999996]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J0750",3,210.53,89.98,1.22,456.36,52.63]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J0750",3,210.53,95.92,1.22,456.36,52.63]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J0750",3,210.53,89.98,1.22,456.36,52.63]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.85]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.85]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J0750",3,210.53,1.22,1.22,456.36,52.63]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J7121",3,15.396666666666667,8.67,3.84,456.36,3.85]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["TUFTS - TUFTS SELECT - HCPCS - J0750",3,210.53,84.21,1.22,456.36,52.63]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["HSN - HSN STANDARD - HCPCS - J0750",3,210.53,456.35999999999996,1.22,456.36,52.63]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J7121",3,15.396666666666667,456.35999999999996,3.84,456.36,3.85]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["TUFTS - TUFTS HMO - HCPCS - J7121",3,15.396666666666667,9.5933333333333337,3.84,456.36,3.85]
["FALLON - FALLON PPO STANDARD - HCPCS - J0750",3,210.53,105.27,1.22,456.36,52.63]
["TUFTS - TUFTS POS - HCPCS - J0750",3,210.53,95.92,1.22,456.36,52.63]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J7121",3,15.396666666666667,8.67,3.84,456.36,3.85]
["TUFTS - TUFTS POS - HCPCS - J7121",3,15.396666666666667,9.5933333333333337,3.84,456.36,3.85]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J7121",3,15.396666666666667,420.34,3.84,456.36,3.8499999999999996]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J0750",3,210.53,1.37,1.22,456.36,52.63]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J7121",3,15.396666666666667,13.086666666666668,3.84,456.36,3.85]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["BCBS - BCBS HMO - HCPCS - J0750",3,210.53,1.37,1.22,456.36,52.63]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["BCBS - BCBS POS - HCPCS - J0750",3,210.53,1.37,1.22,456.36,52.63]
["BCBS - BCBS SHIP PPO - HCPCS - J7121",3,15.396666666666667,11.623333333333333,3.84,456.36,3.8499999999999996]
["WELLCARE - WELLCARE PPO - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0688",2,12.99,5.55,4.32,456.36,3.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J0688",2,12.99,6.87,4.32,456.36,3.25]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J0688",2,12.99,5.55,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J0688",2,12.99,5.55,4.32,456.36,3.25]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J0688",2,12.99,5.55,4.32,456.36,3.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J0688",2,12.99,11.04,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - C9113",2,17.77,17.77,6.4,456.36,4.4400000000000004]
["FALLON - FALLON POS STANDARD - HCPCS - J0688",2,12.99,6.5,4.32,456.36,3.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["FALLON SCO - FALLON SCO HMO - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - C9113",2,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0688",2,12.99,6.5,4.32,456.36,3.25]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J0688",2,12.99,456.36,4.32,456.36,3.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J0688",2,12.99,6.87,4.32,456.36,3.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CCA - CCA SCO STANDARD - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J2270",2,31.34,13.39,11.28,456.36,7.84]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2270",2,31.34,13.39,11.28,456.36,7.84]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["AETNA - AETNA HMO - HCPCS - J0688",2,12.99,6.87,4.32,456.36,3.25]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["UNITED - UNITED DEFINITY HRA - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["BCBS - BCBS POS - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["BCBS - BCBS STANDARD - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["TUFTS - TUFTS SPIRIT - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - A9576",2,5,5,1.58,456.36,1.25]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - C9257",2,35,1.94,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2598",2,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["FALLON - FALLON POS STANDARD - HCPCS - J2270",2,31.34,15.67,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J0702",2,126,126,7.07,456.36,31.5]
["HSN DENTAL - HSN DENTAL - HCPCS - J2270",2,31.34,456.36,11.28,456.36,7.84]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2270",2,31.34,17.649999999999999,11.28,456.36,7.84]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["TUFTS - TUFTS SELECT - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2270",2,31.34,420.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2270",2,31.34,420.34,11.28,456.36,7.84]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J0131",1,42.63,7.06,5.0999999999999996,456.36,10.66]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1817",1,67.430000000000007,35.67,24.27,456.36,16.86]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2930",1,80.260000000000005,42.46,24.44,456.36,20.07]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J1817",1,67.430000000000007,28.82,24.27,456.36,16.86]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2930",1,80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["UNITED - UNITED NAVIGATE - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J0131",1,42.63,18.22,5.0999999999999996,456.36,10.66]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1817",1,67.430000000000007,28.82,24.27,456.36,16.86]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J0131",1,42.63,15.35,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J0131",1,42.63,18.22,5.0999999999999996,456.36,10.66]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1817",1,67.430000000000007,420.34,24.27,456.36,16.86]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J0131",1,42.63,36.24,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["UNICARE - UNICARE STANDARD - HCPCS - J0131",1,42.63,6,5.0999999999999996,456.36,10.66]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED - UNITED DEFINITY HRA - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - S0020",1,6.93,420.34,2.4900000000000002,456.36,1.73]
["UNITED - UNITED NAVIGATE - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1817",1,67.430000000000007,28.82,24.27,456.36,16.86]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - S0020",1,6.93,3.67,2.4900000000000002,456.36,1.73]
["ZZZAETNA - ZZZAETNA POS - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - C9113",1,17.77,15.1,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - C9113",1,17.77,7.59,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1817",1,67.430000000000007,57.32,24.27,456.36,16.86]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2930",1,80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["UNITED - UNITED DEFINITY HRA - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1817",1,67.430000000000007,420.34,24.27,456.36,16.86]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - S0020",1,6.93,5.89,2.4900000000000002,456.36,1.73]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2930",1,80.260000000000005,28.89,24.44,456.36,20.07]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J1817",1,67.430000000000007,28.82,24.27,456.36,16.86]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2930",1,80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1817",1,67.430000000000007,28.82,24.27,456.36,16.86]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J0131",1,42.63,18.22,5.0999999999999996,456.36,10.66]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0131",1,42.63,7.06,5.0999999999999996,456.36,10.66]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["FALLON - FALLON POS STANDARD - HCPCS - C9113",1,17.77,8.89,6.4,456.36,4.4400000000000004]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - C9113",1,17.77,10.01,6.4,456.36,4.4400000000000004]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HSN DENTAL - HSN DENTAL - HCPCS - J0131",1,42.63,456.36,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J7121",1,14.21,14.21,5.12,456.36,3.55]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J1817",1,67.430000000000007,37.979999999999997,24.27,456.36,16.86]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["FALLON - FALLON POS STANDARD - HCPCS - J2930",1,80.260000000000005,40.130000000000003,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS - TUFTS SPIRIT - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HSN - HSN TEMPORARY - HCPCS - J1817",1,67.430000000000007,456.36,24.27,456.36,16.86]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J0131",1,42.63,5.61,5.0999999999999996,456.36,10.66]
["TUFTS - TUFTS CARELINK - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - S0020",1,6.93,3.9,2.4900000000000002,456.36,1.73]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2930",1,80.260000000000005,456.36,24.44,456.36,20.07]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - C9113",1,17.77,456.36,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1817",1,67.430000000000007,456.36,24.27,456.36,16.86]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - C9113",1,17.77,420.34,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CIGNA - CIGNA STANDARD - HCPCS - S0020",1,6.93,5.89,2.4900000000000002,456.36,1.73]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1250",1,9,4.76,3.24,456.36,2.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J3010",1,0.52,0.28000000000000003,0.19,456.36,0.13]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J7307",1,3163,1673.23,420.34,2688.55,790.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1250",1,9,3.85,3.24,456.36,2.25]
["CCA - CCA SCO STANDARD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J8540",1,1,0.53,0.09,456.36,0.25]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CIGNA - CIGNA LOCALPLUS - HCPCS - S0020",1,6.93,5.89,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J3301",1,15,6.41,0.98,456.36,3.75]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2598",1,150.99,128.34,36.299999999999997,456.36,37.75]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J7307",1,3163,2688.55,420.34,2688.55,790.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1250",1,9,4.0999999999999996,3.24,456.36,2.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J0131",1,42.63,7,5.0999999999999996,456.36,10.66]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - Q0249",1,9,6.73,3.24,456.36,2.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1250",1,9,3.85,3.24,456.36,2.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J3590",1,1218,1035.3,420.34,1218,304.5]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J7307",1,3163,2688.55,420.34,2688.55,790.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J7307",1,3163,1673.23,420.34,2688.55,790.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J3301",1,15,6.41,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - Q0249",1,9,3.85,3.24,456.36,2.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["BCBS - BCBS POS - HCPCS - J2930",1,80.260000000000005,34.64,24.44,456.36,20.07]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J7307",1,3163,1114.33,420.34,2688.55,790.75]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - A9576",1,5,2.14,1.58,456.36,1.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["WELLCARE - WELLCARE PPO - HCPCS - C9257",1,35,1.93,1.68,456.36,8.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J3590",1,1218,520.57000000000005,420.34,1218,304.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J3590",1,1218,520.57000000000005,420.34,1218,304.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3590",1,1218,644.32000000000005,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - Q0249",1,9,4.76,3.24,456.36,2.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1250",1,9,3.85,3.24,456.36,2.25]
["CIGNA - CIGNA CARELINK - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J7608",1,13.24,6.83,4.7699999999999996,456.36,3.31]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3590",1,1218,644.32000000000005,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J7307",1,3163,1114.33,420.34,2688.55,790.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS - BCBS PPO - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["BCBS - BCBS SHIP PPO - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["UBH HPHC - UBH HPHC - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["UNICARE - UNICARE STANDARD - HCPCS - J0702",1,126,7.07,7.07,456.36,31.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J7608",1,13.24,5.3,4.7699999999999996,456.36,3.31]
["UNICARE - UNICARE STANDARD - HCPCS - J3590",1,1218,913.5,420.34,1218,304.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["WELLCARE - WELLCARE HMO - HCPCS - J2598",1,150.99,37.75,36.299999999999997,456.36,37.75]
["WELLCARE - WELLCARE HMO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE PPO - HCPCS - J2598",1,150.99,37.75,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["UNITED - UNITED DEFINITY HRA - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["UNITED - UNITED HP SHIP - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3590",1,1218,520.57000000000005,420.34,1218,304.5]
["AETNA - AETNA HMO - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J7608",1,13.24,4.7699999999999996,4.7699999999999996,456.36,3.31]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - A9576",1,5,2.14,1.58,456.36,1.25]
["UNITED - UNITED HP SHIP - HCPCS - J7608",1,13.24,6.83,4.7699999999999996,456.36,3.31]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - A9576",1,5,2.14,1.58,456.36,1.25]
["AETNA - AETNA MCR SUPP - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - A9576",1,5,2.14,1.58,456.36,1.25]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["CCA - CCA SCO ONECARE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["AETNA - AETNA POS - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CCA - ZZZCCA STANDARD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED - UNITED NAVIGATE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["UNITED - UNITED NAVIGATE - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3301",1,15,7.94,0.98,456.36,3.75]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J8540",1,1,0.11,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J3301",1,15,6.41,0.98,456.36,3.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J8540",1,1,0.43,0.09,456.36,0.25]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J7307",1,3163,1114.33,420.34,2688.55,790.75]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["CIGNA - CIGNA CARELINK - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED - UNITED STANDARD - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["UNITED - UNITED STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J1817",1,67.430000000000007,35.67,24.27,456.36,16.86]
["UNITED - UNITED STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J8540",1,1,0.11,0.09,456.36,0.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J8540",1,1,0.43,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["ZZZAETNA - ZZZAETNA POS - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - C9257",1,35,18.52,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J0583",1,266.44,140.94999999999999,55,456.36,66.61]
["UNITED - UNITED NAVIGATE - HCPCS - Q0249",1,9,9,3.24,456.36,2.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS - TUFTS PPO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J7608",1,13.24,9.36,4.7699999999999996,456.36,3.31]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - Q0249",1,9,5.81,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - P9047",1,187,73.5,50.13,456.36,46.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J2598",1,150.99,37.6,36.299999999999997,456.36,37.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J0702",1,126,456.36,7.07,456.36,31.5]
["MEDICARE - MEDICARE A&B - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS - BCBS HMO - HCPCS - J2598",1,150.99,37.6,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J7608",1,13.24,420.34,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CCA - CCA SCO ONECARE - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["BCBS - BCBS HMO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HSN - HSN STANDARD - HCPCS - J7608",1,13.24,456.36,4.7699999999999996,456.36,3.31]
["CCA - CCA SCO ONECARE - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["CCA - CCA SCO STANDARD - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CCA - CCA SCO STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["CCA - CCA SCO STANDARD - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS - TUFTS HMO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS - TUFTS PPO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CCA - ZZZCCA STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3590",1,1218,420.34,420.34,1218,304.5]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["HSN - HSN STANDARD - HCPCS - J3010",1,0.52,456.36,0.19,456.36,0.13]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J3010",1,0.52,456.36,0.19,456.36,0.13]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J3010",1,0.52,456.36,0.19,456.36,0.13]
["CIGNA - CIGNA CARELINK - HCPCS - J7307",1,3163,1192.22,420.34,2688.55,790.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J7307",1,3163,1781.4,420.34,2688.55,790.75]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J0702",1,126,107.1,7.07,456.36,31.5]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J3301",1,15,12.75,0.98,456.36,3.75]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CIGNA - CIGNA STANDARD - HCPCS - J0583",1,266.44,226.47,55,456.36,66.61]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - C9257",1,35,1.68,1.68,456.36,8.75]
["TUFTS - TUFTS HMO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CIGNA - CIGNA STANDARD - HCPCS - J8540",1,1,0.85,0.09,456.36,0.25]
["CIGNA - CIGNA STANDARD - HCPCS - Q0249",1,9,7.65,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J3590",1,1218,644.32000000000005,420.34,1218,304.5]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - P9047",1,187,73.5,50.13,456.36,46.75]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["BCBS - BCBS STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J7307",1,3163,1114.33,420.34,2688.55,790.75]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["HSN - HSN TEMPORARY - HCPCS - C9257",1,35,456.36,1.68,456.36,8.75]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J7608",1,13.24,9.36,4.7699999999999996,456.36,3.31]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - Q0249",1,9,5.81,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2598",1,150.99,39.93,36.299999999999997,456.36,37.75]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - A9576",1,5,2.82,1.58,456.36,1.25]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J3301",1,15,8.4499999999999993,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - A9576",1,5,2.82,1.58,456.36,1.25]
["MEDICARE - MEDICARE A&B - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["MEDICARE - MEDICARE A&B - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["BCBS - BCBS HMO - HCPCS - C9257",1,35,2.27,1.68,456.36,8.75]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS - TUFTS POS - HCPCS - J7307",1,3163,1119.79,420.34,2688.55,790.75]
["BCBS - BCBS POS - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["BCBS - BCBS POS - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS - TUFTS SPIRIT - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS SPIRIT - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - P9047",1,187,420.34,50.13,456.36,46.75]
["BCBS - BCBS POS - HCPCS - J7608",1,13.24,9.36,4.7699999999999996,456.36,3.31]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - C9257",1,35,2.27,1.68,456.36,8.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["BCBS - BCBS PPO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["BCBS - BCBS PPO - HCPCS - J1250",1,9,5.81,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3010",1,0.52,420.34,0.19,456.36,0.13]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - C9257",1,35,2.04,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["AETNA - AETNA MCR SUPP - HCPCS - J8540",1,1,0.11,0.09,456.36,0.25]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["AETNA - AETNA POS - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["AETNA - AETNA POS - HCPCS - J0583",1,266.44,140.94999999999999,55,456.36,66.61]
["AETNA - AETNA HMO - HCPCS - C9257",1,35,18.52,1.68,456.36,8.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AETNA - AETNA HMO - HCPCS - J0583",1,266.44,140.94999999999999,55,456.36,66.61]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["BCBS - BCBS PPO - HCPCS - Q0249",1,9,5.81,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - Q0249",1,9,6.77,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["HSN - HSN STANDARD - HCPCS - Q0249",1,9,456.36,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J1250",1,9,456.36,3.24,456.36,2.25]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J7307",1,3163,456.36,420.34,2688.55,790.75]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - A9576",1,5,456.36,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J8540",1,1,456.36,0.09,456.36,0.25]
["HSN DENTAL - HSN DENTAL - HCPCS - J0583",1,266.44,456.36,55,456.36,66.61]
["HSN DENTAL - HSN DENTAL - HCPCS - J3301",1,15,456.36,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1250",1,9,456.36,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J8540",1,1,456.36,0.09,456.36,0.25]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J7608",1,13.24,7.46,4.7699999999999996,456.36,3.31]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - C9257",1,35,19.71,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - P9047",1,187,105.32,50.13,456.36,46.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J0702",1,126,70.959999999999994,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS - BCBS HMO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["BCBS - BCBS SHIP PPO - HCPCS - J7608",1,13.24,9.36,4.7699999999999996,456.36,3.31]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["AETNA - AETNA PPO EPO - HCPCS - P9047",1,187,98.92,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - P9047",1,187,63.69,50.13,456.36,46.75]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS HMO - HCPCS - C9257",1,35,12.3,1.68,456.36,8.75]
["TUFTS - TUFTS HMO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS - TUFTS POS - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS - TUFTS POS - HCPCS - J7608",1,13.24,7.57,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS - TUFTS POS - HCPCS - P9047",1,187,53.76,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J1250",1,9,4.76,3.24,456.36,2.25]
["AETNA - AETNA MCR SUPP - HCPCS - J1250",1,9,4.76,3.24,456.36,2.25]
["TUFTS - TUFTS PPO - HCPCS - C9257",1,35,13.1,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS - TUFTS PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS - TUFTS PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS - TUFTS PPO - HCPCS - J7608",1,13.24,8.06,4.7699999999999996,456.36,3.31]
["BCBS - BCBS STANDARD - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS PPO - HCPCS - P9047",1,187,57.24,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS - TUFTS SELECT - HCPCS - C9257",1,35,12,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS - TUFTS SELECT - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS - TUFTS SELECT - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["TUFTS - TUFTS SELECT - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS - BCBS STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS - TUFTS SELECT - HCPCS - J7608",1,13.24,7.39,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS - TUFTS SELECT - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2598",1,150.99,79.87,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS SPIRIT - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS - TUFTS SPIRIT - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["BCBS - BCBS STANDARD - HCPCS - J1250",1,9,5.81,3.24,456.36,2.25]
["TUFTS - TUFTS SPIRIT - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS SPIRIT - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS - TUFTS SPIRIT - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["AETNA - AETNA MCR SUPP - HCPCS - J2598",1,150.99,79.87,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - A9576",1,5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - C9257",1,35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0583",1,266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0702",1,126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1250",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2598",1,150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3010",1,0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - Q0249",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["AETNA - AETNA MCR SUPP - HCPCS - J3010",1,0.52,0.28000000000000003,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["FALLON - FALLON HMO STANDARD - HCPCS - A9576",1,5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON HMO STANDARD - HCPCS - C9257",1,35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J0583",1,266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J0702",1,126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J1250",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["BCBS - BCBS STANDARD - HCPCS - J2598",1,150.99,37.6,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J2598",1,150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2598",1,150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J3010",1,0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J3301",1,15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J7608",1,13.24,7,4.7699999999999996,456.36,3.31]
["FALLON - FALLON HMO STANDARD - HCPCS - J7307",1,3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - C9257",1,35,420.34,1.68,456.36,8.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J7608",1,13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J0702",1,126,420.34,7.07,456.36,31.5]
["FALLON - FALLON HMO STANDARD - HCPCS - J8540",1,1,0.5,0.09,456.36,0.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["FALLON - FALLON HMO STANDARD - HCPCS - P9047",1,187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3010",1,0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON HMO STANDARD - HCPCS - Q0249",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3590",1,1218,420.34,420.34,1218,304.5]
["AETNA - AETNA MCR SUPP - HCPCS - J3301",1,15,7.94,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J7608",1,13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON POS STANDARD - HCPCS - A9576",1,5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - P9047",1,187,420.34,50.13,456.36,46.75]
["FALLON - FALLON POS STANDARD - HCPCS - C9257",1,35,17.5,1.68,456.36,8.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J8540",1,1,0.53,0.09,456.36,0.25]
["FALLON - FALLON POS STANDARD - HCPCS - J0583",1,266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - C9257",1,35,2.56,1.68,456.36,8.75]
["FALLON - FALLON POS STANDARD - HCPCS - J0702",1,126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["FALLON - FALLON POS STANDARD - HCPCS - J1250",1,9,4.5,3.24,456.36,2.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J1250",1,9,5.81,3.24,456.36,2.25]
["BCBS - BCBS STANDARD - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["FALLON - FALLON POS STANDARD - HCPCS - J2598",1,150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["FALLON - FALLON POS STANDARD - HCPCS - J3010",1,0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - P9047",1,187,73.5,50.13,456.36,46.75]
["FALLON - FALLON POS STANDARD - HCPCS - J3301",1,15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["FALLON - FALLON POS STANDARD - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["FALLON - FALLON POS STANDARD - HCPCS - J7307",1,3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON POS STANDARD - HCPCS - J7608",1,13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON - FALLON POS STANDARD - HCPCS - J8540",1,1,0.5,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["FALLON - FALLON POS STANDARD - HCPCS - P9047",1,187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON POS STANDARD - HCPCS - Q0249",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - HCPCS - J3590",1,1218,644.32000000000005,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON PPO STANDARD - HCPCS - A9576",1,5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["FALLON - FALLON PPO STANDARD - HCPCS - C9257",1,35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["FALLON - FALLON PPO STANDARD - HCPCS - J0583",1,266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["FALLON - FALLON PPO STANDARD - HCPCS - J0702",1,126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2598",1,150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON - FALLON PPO STANDARD - HCPCS - J1250",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS - BCBS STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["FALLON - FALLON PPO STANDARD - HCPCS - J2598",1,150.99,75.5,36.299999999999997,456.36,37.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J3010",1,0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - C9257",1,35,420.34,1.68,456.36,8.75]
["FALLON - FALLON PPO STANDARD - HCPCS - J3301",1,15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0702",1,126,420.34,7.07,456.36,31.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["FALLON - FALLON PPO STANDARD - HCPCS - J7307",1,3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3010",1,0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON PPO STANDARD - HCPCS - J7608",1,13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3590",1,1218,420.34,420.34,1218,304.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J8540",1,1,0.5,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J7608",1,13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON PPO STANDARD - HCPCS - P9047",1,187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - P9047",1,187,420.34,50.13,456.36,46.75]
["FALLON - FALLON PPO STANDARD - HCPCS - Q0249",1,9,4.5,3.24,456.36,2.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["AETNA - AETNA MCR SUPP - HCPCS - J7307",1,3163,1673.23,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - C9257",1,35,2.56,1.68,456.36,8.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - P9047",1,187,73.5,50.13,456.36,46.75]
["BCBS - BCBS STANDARD - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - HCPCS - J7608",1,13.24,7,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2598",1,150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS - BCBS STANDARD - HCPCS - J7307",1,3163,1318.16,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - C9257",1,35,420.34,1.68,456.36,8.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0702",1,126,420.34,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3301",1,15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3010",1,0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3590",1,1218,420.34,420.34,1218,304.5]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7307",1,3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J7608",1,13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7608",1,13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - P9047",1,187,420.34,50.13,456.36,46.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J8540",1,1,0.5,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - P9047",1,187,93.5,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["Grand Total",72375,289.53623474957016,153.32708891193568,0.03,7890.89,72.384868393797007]

{"sheet":"HCPCS Pivot Data","index":21,"n_rows":7726,"n_cols":7,"rows_kept":2250,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
["Payer - Plan - Bill Type - Bill Code","Sum of Duplicates","Average of Gross Charge Amount","Average of Payer Charge Amount","Min of Minimum Charge Amount","Max of Maximum Charge Amount","Average of Self-Pay Charge"]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2001",102,4.1013725490196133,4.1013725490196133,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2001",102,4.1013725490196125,4.1013725490196125,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J3490",94,454.52787234042518,454.52787234042518,0.41,7676.82,113.63319148936165]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J3490",94,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2704",90,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2704",90,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J0690",62,12.164516129032263,12.164516129032263,0.17,456.36,3.0412903225806467]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J0690",62,12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1953",54,62.176666666666641,62.176666666666641,3.5,456.36,15.54555555555555]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1170",54,71.055925925925976,71.055925925925976,0.23,511.56,17.765555555555558]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1170",54,71.055925925925976,71.055925925925976,0.23,511.56,17.765555555555562]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1953",54,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2001",51,4.1013725490196062,2.1713725490196083,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J2001",51,4.1013725490196071,1.7537254901960793,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2001",51,4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470591]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2001",51,4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J2001",51,4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2001",51,4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2001",51,4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470587]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J2001",51,4.101372549019608,2.1713725490196079,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2001",51,4.101372549019608,3.4850980392156861,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2001",51,4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2001",51,4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2001",51,4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J2001",51,4.101372549019608,1.7537254901960793,0.03,456.36,1.0252941176470587]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2001",51,4.1013725490196071,1.753725490196079,0.03,456.36,1.0252941176470587]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2001",51,4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J2001",51,4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470589]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470591]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470589]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J2001",51,4.101372549019608,2.1713725490196083,0.03,456.36,1.0252941176470589]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2001",51,4.101372549019608,3.4850980392156852,0.03,456.36,1.0252941176470591]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2001",51,4.1013725490196062,1.753725490196079,0.03,456.36,1.0252941176470589]
["UBH HPHC - UBH HPHC - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J2001",51,4.1013725490196062,1.7537254901960784,0.03,456.36,1.0252941176470591]
["UNICARE - UNICARE STANDARD - HCPCS - J2001",51,4.1013725490196071,2.6647058823529424,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["UNITED - UNITED DEFINITY HRA - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J2001",51,4.101372549019608,1.7537254901960784,0.03,456.36,1.0252941176470589]
["UNITED - UNITED NAVIGATE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J2001",51,4.101372549019608,1.753725490196079,0.03,456.36,1.0252941176470587]
["UNITED - UNITED STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2001",51,4.101372549019608,1.7537254901960784,0.03,456.36,1.0252941176470591]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2001",51,4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470589]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2001",51,4.101372549019608,1.753725490196079,0.03,456.36,1.0252941176470591]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470594]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2001",51,4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2001",51,4.101372549019608,1.7537254901960784,0.03,456.36,1.0252941176470589]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2001",51,4.1013725490196071,1.753725490196079,0.03,456.36,1.0252941176470591]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2001",51,4.1013725490196062,2.1713725490196083,0.03,456.36,1.0252941176470589]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2001",51,4.1013725490196071,2.1713725490196079,0.03,456.36,1.0252941176470589]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J2001",51,4.1013725490196071,1.6384313725490203,0.03,456.36,1.0252941176470591]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J2001",51,4.101372549019608,1.753725490196079,0.03,456.36,1.0252941176470591]
["WELLCARE - WELLCARE HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470587]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WELLCARE - WELLCARE PPO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2001",51,4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470587]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2001",51,4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2001",51,4.1013725490196071,1.4776470588235289,0.03,456.36,1.0252941176470591]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J2001",51,4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2001",51,4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2001",51,4.1013725490196071,456.3600000000003,0.03,456.36,1.0252941176470587]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["FALLON - FALLON PPO STANDARD - HCPCS - J2001",51,4.1013725490196062,2.0545098039215683,0.03,456.36,1.0252941176470585]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2001",51,4.1013725490196062,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS POS - HCPCS - J2001",51,4.1013725490196071,2.35,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["FALLON - FALLON HMO STANDARD - HCPCS - J2001",51,4.101372549019608,2.0545098039215688,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2001",51,4.1013725490196071,2.3109803921568632,0.03,456.36,1.0252941176470589]
["HSN - HSN STANDARD - HCPCS - J2001",51,4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2001",51,4.1013725490196071,2.3109803921568628,0.03,456.36,1.0252941176470587]
["HSN DENTAL - HSN DENTAL - HCPCS - J2001",51,4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470591]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["MEDICARE - MEDICARE A&B - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS CARELINK - HCPCS - J2001",51,4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470587]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS SELECT - HCPCS - J2001",51,4.101372549019608,2.1700000000000008,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2001",51,4.1013725490196062,2.0545098039215688,0.03,456.36,1.0252941176470587]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470594]
["FALLON - FALLON POS STANDARD - HCPCS - J2001",51,4.101372549019608,2.0545098039215679,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HSN - HSN TEMPORARY - HCPCS - J2001",51,4.1013725490196071,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2001",51,4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2001",51,4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2001",51,4.101372549019608,2.3109803921568628,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2001",51,4.101372549019608,2.3109803921568628,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470585]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS HMO - HCPCS - J2001",51,4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS PPO - HCPCS - J2001",51,4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS SPIRIT - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470585]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470587]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2001",51,4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
["CIGNA - CIGNA CARELINK - HCPCS - J2001",51,4.1013725490196062,2.35,0.03,456.36,1.0252941176470589]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J2001",51,4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CCA - ZZZCCA STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2001",51,4.101372549019608,2.9639215686274518,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CCA - CCA SCO ONECARE - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["AETNA - AETNA HMO - HCPCS - J2001",51,4.1013725490196071,2.1713725490196074,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AETNA - AETNA MCR SUPP - HCPCS - J2001",51,4.1013725490196071,2.1713725490196087,0.03,456.36,1.0252941176470591]
["CIGNA - CIGNA STANDARD - HCPCS - J2001",51,4.101372549019608,3.4850980392156847,0.03,456.36,1.0252941176470591]
["AETNA - AETNA POS - HCPCS - J2001",51,4.101372549019608,2.1713725490196083,0.03,456.36,1.0252941176470591]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["AETNA - AETNA PPO EPO - HCPCS - J2001",51,4.1013725490196062,2.171372549019607,0.03,456.36,1.0252941176470587]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2001",51,4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2001",51,4.1013725490196071,2.1713725490196079,0.03,456.36,1.0252941176470587]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J2001",51,4.101372549019608,2.9639215686274518,0.03,456.36,1.0252941176470589]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2001",51,4.1013725490196071,2.9639215686274527,0.03,456.36,1.0252941176470594]
["BCBS - BCBS HMO - HCPCS - J2001",51,4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CCA - CCA SCO STANDARD - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["BCBS - BCBS INDEMNITY - HCPCS - J2001",51,4.1013725490196062,2.9639215686274527,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS POS - HCPCS - J2001",51,4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS PPO - HCPCS - J2001",51,4.1013725490196071,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2001",51,4.101372549019608,3.4850980392156838,0.03,456.36,1.0252941176470585]
["BCBS - BCBS SHIP PPO - HCPCS - J2001",51,4.1013725490196062,2.9639215686274532,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS STANDARD - HCPCS - J2001",51,4.101372549019608,2.9639215686274527,0.03,456.36,1.0252941176470587]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2001",51,4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2001",51,4.101372549019608,2.9639215686274527,0.03,456.36,1.0252941176470589]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J2001",51,4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J3490",47,454.52787234042535,386.34808510638294,0.41,7676.82,113.63319148936164]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3490",47,454.52787234042546,240.44595744680842,0.41,7676.82,113.63319148936164]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J3490",47,454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936161]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J3490",47,454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936164]
["UNITED - UNITED DEFINITY HRA - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936166]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3490",47,454.52787234042557,240.44595744680848,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J3490",47,454.52787234042557,194.26404255319147,0.41,7676.82,113.63319148936165]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J3490",47,454.52787234042557,240.44595744680842,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3490",47,454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936164]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J3490",47,454.52787234042557,386.348085106383,0.41,7676.82,113.63319148936169]
["UNITED - UNITED NAVIGATE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J3490",47,454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936171]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3490",47,454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J3490",47,454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J3490",47,454.52787234042557,194.26404255319156,0.41,7676.82,113.63319148936169]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J3490",47,454.52787234042523,240.44595744680842,0.41,7676.82,113.63319148936159]
["UNITED - UNITED STANDARD - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J3490",47,454.5278723404254,240.44595744680845,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J3490",47,454.52787234042523,194.26404255319147,0.41,7676.82,113.63319148936159]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J3490",47,454.5278723404254,194.26404255319153,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J3490",47,454.52787234042563,194.26404255319147,0.41,7676.82,113.63319148936171]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J3490",47,454.52787234042546,301.41787234042562,0.41,7676.82,113.63319148936169]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J3490",47,454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936169]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936166]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936169]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J3490",47,454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936171]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J3490",47,454.52787234042563,194.26404255319153,0.41,7676.82,113.63319148936171]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J3490",47,454.5278723404254,181.81170212765952,0.41,7676.82,113.63319148936161]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936165]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J3490",47,454.52787234042535,194.26404255319153,0.41,7676.82,113.63319148936161]
["WELLCARE - WELLCARE HMO - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936164]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J3490",47,454.52787234042535,194.26404255319156,0.41,7676.82,113.63319148936165]
["WELLCARE - WELLCARE PPO - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936165]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J3490",47,454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J3490",47,454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936164]
["WELLCARE - WELLCARE STANDARD - HCPCS - J3490",47,454.52787234042569,454.52787234042569,0.41,7676.82,113.63319148936169]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J3490",47,454.52787234042546,163.63042553191491,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3490",47,454.5278723404254,420.34000000000009,0.41,7676.82,113.63319148936159]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J3490",47,454.52787234042557,420.34000000000009,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3490",47,454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936166]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936159]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3490",47,454.52787234042563,420.34000000000009,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J3490",47,454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936169]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J3490",47,454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J3490",47,454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936165]
["UNICARE - UNICARE STANDARD - HCPCS - J3490",47,454.5278723404254,340.89723404255318,0.41,7676.82,113.63319148936164]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936165]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J3490",47,454.52787234042546,194.26404255319147,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J3490",47,454.52787234042546,194.26404255319147,0.41,7676.82,113.63319148936169]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3490",47,454.52787234042546,227.26680851063824,0.41,7676.82,113.63319148936164]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936159]
["FALLON - FALLON PPO STANDARD - HCPCS - J3490",47,454.52787234042546,227.26680851063824,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936172]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J3490",47,454.52787234042523,420.34000000000009,0.41,7676.82,113.63319148936164]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936172]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["FALLON - FALLON HMO STANDARD - HCPCS - J3490",47,454.5278723404254,227.26680851063824,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936166]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["FALLON SCO - FALLON SCO HMO - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936165]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["HSN - HSN STANDARD - HCPCS - J3490",47,454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936171]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936165]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936175]
["FALLON - FALLON POS STANDARD - HCPCS - J3490",47,454.52787234042523,227.26680851063821,0.41,7676.82,113.63319148936169]
["HSN - HSN TEMPORARY - HCPCS - J3490",47,454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936171]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J3490",47,454.52787234042563,255.99127659574469,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J3490",47,454.52787234042569,456.3600000000003,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936165]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J3490",47,454.5278723404254,456.3600000000003,0.41,7676.82,113.63319148936166]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936164]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936165]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["HSN DENTAL - HSN DENTAL - HCPCS - J3490",47,454.5278723404254,456.3600000000003,0.41,7676.82,113.63319148936166]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J3490",47,454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936171]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J3490",47,454.52787234042563,456.3600000000003,0.41,7676.82,113.63319148936171]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J3490",47,454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936165]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS CARELINK - HCPCS - J3490",47,454.5278723404254,298.5776595744681,0.41,7676.82,113.63319148936165]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS HMO - HCPCS - J3490",47,454.52787234042557,298.29744680851064,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS POS - HCPCS - J3490",47,454.5278723404254,298.29744680851076,0.41,7676.82,113.63319148936165]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J3490",47,454.52787234042557,255.99127659574481,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS PPO - HCPCS - J3490",47,454.52787234042557,298.57765957446804,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TUFTS - TUFTS SELECT - HCPCS - J3490",47,454.52787234042523,283.46468085106397,0.41,7676.82,113.63319148936164]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J3490",47,454.52787234042535,255.99127659574458,0.41,7676.82,113.63319148936161]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J3490",47,454.52787234042535,255.99127659574461,0.41,7676.82,113.63319148936156]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3490",47,454.52787234042557,420.34000000000009,0.41,7676.82,113.63319148936171]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J3490",47,454.52787234042557,240.44595744680845,0.41,7676.82,113.63319148936169]
["AETNA - AETNA PPO EPO - HCPCS - J3490",47,454.52787234042557,240.44595744680842,0.41,7676.82,113.63319148936166]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936172]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936164]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["AETNA - AETNA HMO - HCPCS - J3490",47,454.52787234042546,240.44595744680853,0.41,7676.82,113.63319148936171]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["BCBS - BCBS SHIP PPO - HCPCS - J3490",47,454.52787234042546,349.57723404255319,0.41,7676.82,113.63319148936169]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3490",47,454.5278723404254,349.5772340425533,0.41,7676.82,113.63319148936164]
["BCBS - BCBS STANDARD - HCPCS - J3490",47,454.52787234042557,349.57723404255313,0.41,7676.82,113.63319148936166]
["BCBS - BCBS HMO - HCPCS - J3490",47,454.5278723404254,349.57723404255319,0.41,7676.82,113.63319148936165]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J3490",47,454.52787234042535,349.5772340425533,0.41,7676.82,113.63319148936169]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J3490",47,454.5278723404254,349.57723404255319,0.41,7676.82,113.63319148936165]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["AETNA - AETNA MCR SUPP - HCPCS - J3490",47,454.52787234042546,240.44595744680845,0.41,7676.82,113.63319148936165]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J3490",47,454.52787234042546,349.5772340425533,0.41,7676.82,113.63319148936165]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J3490",47,454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["BCBS - BCBS INDEMNITY - HCPCS - J3490",47,454.52787234042557,349.57723404255313,0.41,7676.82,113.63319148936169]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936165]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J3490",47,454.52787234042557,349.57723404255319,0.41,7676.82,113.63319148936172]
["CIGNA - CIGNA CARELINK - HCPCS - J3490",47,454.52787234042535,301.41787234042562,0.41,7676.82,113.63319148936166]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936161]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J3490",47,454.5278723404254,386.34808510638294,0.41,7676.82,113.63319148936166]
["CCA - CCA SCO ONECARE - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["CIGNA - CIGNA STANDARD - HCPCS - J3490",47,454.52787234042563,386.34808510638277,0.41,7676.82,113.63319148936164]
["BCBS - BCBS POS - HCPCS - J3490",47,454.52787234042523,349.5772340425533,0.41,7676.82,113.63319148936164]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J3490",47,454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["CCA - CCA SCO STANDARD - HCPCS - J3490",47,454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["AETNA - AETNA POS - HCPCS - J3490",47,454.52787234042557,240.44595744680848,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CCA - ZZZCCA STANDARD - HCPCS - J3490",47,454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["BCBS - BCBS PPO - HCPCS - J3490",47,454.52787234042546,349.57723404255319,0.41,7676.82,113.63319148936165]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J3490",47,454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TUFTS - TUFTS SPIRIT - HCPCS - J3490",46,447.6991304347826,447.6991304347826,0.41,7676.82,111.92608695652173]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2704",45,17.345111111111127,9.175333333333338,0.88,456.36,4.3362222222222249]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J2704",45,17.345111111111127,7.4124444444444473,0.88,456.36,4.3362222222222249]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2704",45,17.345111111111123,420.34000000000009,0.88,456.36,4.336222222222224]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2704",45,17.345111111111127,7.4124444444444473,0.88,456.36,4.336222222222224]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222249]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2704",45,17.345111111111134,14.740444444444456,0.88,456.36,4.3362222222222258]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2704",45,17.34511111111112,420.34000000000009,0.88,456.36,4.3362222222222231]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2704",45,17.345111111111127,7.4124444444444455,0.88,456.36,4.3362222222222249]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2704",45,17.345111111111127,420.34000000000009,0.88,456.36,4.3362222222222249]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2704",45,17.345111111111123,7.4124444444444446,0.88,456.36,4.3362222222222231]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2704",45,17.345111111111127,9.175333333333338,0.88,456.36,4.3362222222222231]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
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["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2704",45,17.345111111111123,7.4124444444444455,0.88,456.36,4.3362222222222231]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222284]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2704",45,17.345111111111127,7.4124444444444482,0.88,456.36,4.3362222222222249]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2704",45,17.345111111111123,7.4124444444444428,0.88,456.36,4.336222222222224]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2704",45,17.345111111111127,7.4124444444444455,0.88,456.36,4.3362222222222249]
["UBH HPHC - UBH HPHC - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2704",45,17.34511111111112,7.4124444444444446,0.88,456.36,4.3362222222222231]
["UBH HPHC - UBH HPHC - HCPCS - J3490",45,471.94533333333328,471.94533333333328,0.41,7676.82,117.98755555555545]
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["UNICARE - UNICARE STANDARD - HCPCS - J2704",45,17.34511111111112,4.7377777777777759,0.88,456.36,4.3362222222222231]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
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["UNITED - UNITED NAVIGATE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
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["UNITED - UNITED PASSPORT CONNECT - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2704",45,17.345111111111123,7.4124444444444455,0.88,456.36,4.3362222222222249]
["UNITED - UNITED STANDARD - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222249]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J2704",45,17.345111111111123,7.4124444444444446,0.88,456.36,4.336222222222224]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2704",45,17.345111111111127,420.34000000000009,0.88,456.36,4.3362222222222258]
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["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2704",45,17.34511111111112,7.4124444444444428,0.88,456.36,4.3362222222222222]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2704",45,17.34511111111113,7.4124444444444473,0.88,456.36,4.3362222222222275]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222275]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2704",45,17.34511111111112,420.34000000000009,0.88,456.36,4.3362222222222222]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J2704",45,17.345111111111127,7.4124444444444482,0.88,456.36,4.3362222222222258]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2704",45,17.34511111111112,7.4124444444444428,0.88,456.36,4.336222222222224]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2704",45,17.345111111111127,7.4124444444444446,0.88,456.36,4.3362222222222258]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J2704",45,17.345111111111123,420.34000000000009,0.88,456.36,4.3362222222222249]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J2704",45,17.345111111111127,9.1753333333333398,0.88,456.36,4.336222222222224]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J2704",45,17.34511111111112,6.940888888888888,0.88,456.36,4.336222222222224]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J2704",45,17.34511111111113,9.1753333333333416,0.88,456.36,4.3362222222222266]
["WELLCARE - WELLCARE HMO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["WELLCARE - WELLCARE PPO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222249]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J2704",45,17.34511111111112,7.4124444444444446,0.88,456.36,4.3362222222222231]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2704",45,17.345111111111127,6.2466666666666644,0.88,456.36,4.3362222222222249]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222275]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2704",45,17.345111111111127,7.4124444444444455,0.88,456.36,4.3362222222222258]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222266]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J3490",45,471.94533333333317,471.94533333333317,0.41,7676.82,117.98755555555553]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J2704",45,17.345111111111123,7.4124444444444428,0.88,456.36,4.3362222222222231]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222275]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2704",45,17.34511111111112,7.4124444444444455,0.88,456.36,4.3362222222222231]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2704",45,17.34511111111113,7.4124444444444473,0.88,456.36,4.3362222222222258]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J3490",45,471.94533333333328,471.94533333333328,0.41,7676.82,117.9875555555555]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J2704",45,17.34511111111113,7.4124444444444473,0.88,456.36,4.3362222222222266]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J2704",45,17.345111111111123,7.4124444444444428,0.88,456.36,4.336222222222224]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2704",45,17.345111111111127,7.4124444444444428,0.88,456.36,4.3362222222222258]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J2704",45,17.345111111111127,7.4124444444444446,0.88,456.36,4.3362222222222249]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J2704",45,17.345111111111137,17.345111111111137,0.88,456.36,4.3362222222222275]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS CARELINK - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["MEDICARE - MEDICARE A&B - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J3490",45,471.94533333333351,471.94533333333351,0.41,7676.82,117.98755555555557]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222222]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["TUFTS - TUFTS PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2704",45,17.34511111111112,456.36000000000024,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2704",45,17.345111111111123,456.36000000000024,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2704",45,17.345111111111127,9.7657777777777817,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222275]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2704",45,17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222222]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2704",45,17.345111111111123,8.6742222222222285,0.88,456.36,4.3362222222222249]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["FALLON - FALLON HMO STANDARD - HCPCS - J2704",45,17.345111111111127,8.6742222222222285,0.88,456.36,4.3362222222222258]
["TUFTS - TUFTS HMO - HCPCS - J2704",45,17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222222]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS SELECT - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["FALLON - FALLON POS STANDARD - HCPCS - J2704",45,17.34511111111112,8.6742222222222249,0.88,456.36,4.3362222222222231]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2704",45,17.345111111111127,456.36000000000024,0.88,456.36,4.336222222222224]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2704",45,17.345111111111127,420.34000000000009,0.88,456.36,4.3362222222222258]
["HSN DENTAL - HSN DENTAL - HCPCS - J2704",45,17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222258]
["FALLON - FALLON PPO STANDARD - HCPCS - J2704",45,17.345111111111127,8.6742222222222285,0.88,456.36,4.336222222222224]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2704",45,17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222249]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2704",45,17.34511111111112,9.7657777777777799,0.88,456.36,4.3362222222222231]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2704",45,17.345111111111123,9.7657777777777817,0.88,456.36,4.3362222222222231]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2704",45,17.345111111111127,9.7657777777777817,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MEDICARE - MEDICARE A&B - HCPCS - J3490",45,471.94533333333345,471.94533333333345,0.41,7676.82,117.98755555555557]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3490",45,471.94533333333345,471.94533333333345,0.41,7676.82,117.98755555555555]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J3490",45,471.94533333333317,471.94533333333317,0.41,7676.82,117.98755555555555]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222222]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222266]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222258]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J2704",45,17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222266]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS POS - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HSN - HSN STANDARD - HCPCS - J2704",45,17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS SPIRIT - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222222]
["HSN - HSN TEMPORARY - HCPCS - J2704",45,17.34511111111113,456.36000000000024,0.88,456.36,4.3362222222222249]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2704",45,17.34511111111112,420.34000000000009,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222258]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CCA - CCA SCO STANDARD - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["BCBS - BCBS POS - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CIGNA - CIGNA CARELINK - HCPCS - J2704",45,17.345111111111137,17.345111111111137,0.88,456.36,4.3362222222222275]
["BCBS - BCBS PPO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["BCBS - BCBS INDEMNITY - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["AETNA - AETNA HMO - HCPCS - J2704",45,17.34511111111112,9.175333333333338,0.88,456.36,4.336222222222224]
["CCA - ZZZCCA STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS - BCBS SHIP PPO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS - BCBS STANDARD - HCPCS - J2704",45,17.345111111111137,17.345111111111137,0.88,456.36,4.3362222222222275]
["CIGNA - CIGNA STANDARD - HCPCS - J2704",45,17.345111111111127,14.740444444444458,0.88,456.36,4.3362222222222258]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704",45,17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["AETNA - AETNA MCR SUPP - HCPCS - J2704",45,17.34511111111113,9.1753333333333398,0.88,456.36,4.3362222222222258]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2704",45,17.34511111111112,9.1753333333333345,0.88,456.36,4.3362222222222213]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2704",45,17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222275]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2704",45,17.34511111111112,14.740444444444446,0.88,456.36,4.3362222222222231]
["AETNA - AETNA POS - HCPCS - J2704",45,17.345111111111123,9.175333333333338,0.88,456.36,4.336222222222224]
["BCBS - BCBS HMO - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J2704",45,17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J2704",45,17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["AETNA - AETNA PPO EPO - HCPCS - J2704",45,17.345111111111127,9.1753333333333398,0.88,456.36,4.3362222222222249]
["CCA - CCA SCO ONECARE - HCPCS - J2704",45,17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1815",32,41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1815",32,41.60625000000001,41.60625000000001,1.62,456.36,10.403750000000002]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1580",32,40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999997]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1580",32,40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999998]
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["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1170",27,71.055925925925933,60.399259259259253,0.23,511.56,17.765555555555558]
["WELLCARE - WELLCARE HMO - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["UBH HPHC - UBH HPHC - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["WELLCARE - WELLCARE PPO - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.54555555555555]
["WELLCARE - WELLCARE PPO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.54555555555555]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1953",27,62.176666666666669,420.34000000000009,3.5,456.36,15.545555555555552]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1170",27,71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555562]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1953",27,62.176666666666655,420.34000000000009,3.5,456.36,15.545555555555554]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J1170",27,71.055925925925919,25.580370370370375,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J1170",27,71.055925925925933,30.369259259259259,0.23,511.56,17.765555555555554]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J1953",27,62.176666666666648,22.383333333333333,3.5,456.36,15.545555555555556]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J1170",27,71.055925925925948,30.369259259259255,0.23,511.56,17.765555555555558]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J1170",27,71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J1170",27,71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148148]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J0690",27,12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148148]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.54555555555555]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J1170",27,71.055925925925933,30.369259259259252,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148148]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1953",27,62.176666666666648,420.34000000000009,3.5,456.36,15.545555555555552]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1170",27,71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555551]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J1170",27,71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555552]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1170",27,71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J1953",27,62.176666666666655,26.574444444444453,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1953",27,62.176666666666669,26.574444444444438,3.5,456.36,15.545555555555554]
["UNITED - UNITED NAVIGATE - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J1953",27,62.176666666666655,32.891111111111115,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1170",27,71.055925925925948,30.369259259259248,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1953",27,62.176666666666669,26.574444444444445,3.5,456.36,15.545555555555556]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J1953",27,62.176666666666648,32.891111111111115,3.5,456.36,15.54555555555555]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J1953",27,62.176666666666641,32.891111111111115,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555551]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1953",27,62.176666666666669,26.574444444444445,3.5,456.36,15.545555555555556]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1953",27,62.176666666666655,32.891111111111115,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1170",27,71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1170",27,71.055925925925919,37.589259259259265,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1953",27,62.176666666666655,26.574444444444438,3.5,456.36,15.545555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J0690",27,12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555556]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J1170",27,71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555554]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J1953",27,62.176666666666648,26.574444444444445,3.5,456.36,15.545555555555554]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J1170",27,71.055925925925919,60.39925925925926,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J1170",27,71.055925925925948,30.369259259259266,0.23,511.56,17.765555555555562]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1170",27,71.055925925925933,64.286666666666676,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J1953",27,62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555552]
["UBH HPHC - UBH HPHC - HCPCS - J0690",27,11.837407407407408,11.837407407407408,0.17,456.36,2.9596296296296294]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1953",27,62.176666666666655,52.847777777777772,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1170",27,71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555554]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J1953",27,62.176666666666655,26.574444444444449,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1953",27,62.176666666666648,26.574444444444438,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1170",27,71.055925925925919,420.34000000000009,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1170",27,71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555558]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555556]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1953",27,62.176666666666648,26.574444444444435,3.5,456.36,15.545555555555556]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["UNICARE - UNICARE STANDARD - HCPCS - J1170",27,71.055925925925933,36.827777777777769,0.23,511.56,17.765555555555558]
["UNICARE - UNICARE STANDARD - HCPCS - J1953",27,62.176666666666648,5.833333333333333,3.5,456.36,15.545555555555554]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J0690",27,11.837407407407408,11.837407407407408,0.17,456.36,2.9596296296296307]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1170",27,71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1170",27,71.055925925925919,420.34000000000009,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1953",27,62.176666666666641,26.574444444444438,3.5,456.36,15.545555555555552]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1170",27,71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555554]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1953",27,62.176666666666648,26.574444444444435,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["HSN - HSN STANDARD - HCPCS - J1170",27,71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555558]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J1953",27,62.176666666666655,456.36000000000013,3.5,456.36,15.545555555555552]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1170",27,71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["TUFTS - TUFTS SELECT - HCPCS - J1170",27,71.055925925925919,63.595555555555563,0.23,511.56,17.765555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS - TUFTS CARELINK - HCPCS - J1170",27,71.055925925925919,64.286666666666662,0.23,511.56,17.765555555555554]
["HSN DENTAL - HSN DENTAL - HCPCS - J1170",27,71.055925925925933,456.36000000000013,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["HSN DENTAL - HSN DENTAL - HCPCS - J1953",27,62.176666666666648,456.36000000000013,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J1170",27,71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555562]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555556]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["FALLON - FALLON HMO STANDARD - HCPCS - J1170",27,71.055925925925919,35.53037037037037,0.23,511.56,17.765555555555554]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1170",27,71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1953",27,62.176666666666648,456.36000000000013,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["TUFTS - TUFTS POS - HCPCS - J1170",27,71.055925925925919,64.286666666666662,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1170",27,71.055925925925948,420.34000000000009,0.23,511.56,17.765555555555558]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1170",27,71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1953",27,62.176666666666655,456.36000000000013,3.5,456.36,15.545555555555554]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555556]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1170",27,71.055925925925919,35.53037037037037,0.23,511.56,17.765555555555554]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J0690",27,12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J1953",27,62.176666666666641,62.176666666666641,3.5,456.36,15.545555555555552]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555556]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J0690",27,12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J1170",27,71.055925925925919,40.018148148148157,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["FALLON SCO - FALLON SCO HMO - HCPCS - J0690",27,12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J1170",27,71.055925925925919,40.018148148148157,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS - TUFTS CARELINK - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["TUFTS - TUFTS POS - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["HSN - HSN TEMPORARY - HCPCS - J1170",27,71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555554]
["TUFTS - TUFTS SELECT - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J1170",27,71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J1170",27,71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["AETNA - AETNA MCR SUPP - HCPCS - J1953",27,62.176666666666655,32.891111111111108,3.5,456.36,15.545555555555552]
["CCA - CCA SCO ONECARE - HCPCS - J1953",27,62.176666666666669,62.176666666666669,3.5,456.36,15.545555555555554]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J1953",27,62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J1170",27,71.055925925925933,66.654444444444451,0.23,511.56,17.765555555555554]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["BCBS - BCBS HMO - HCPCS - J1170",27,71.055925925925919,66.654444444444437,0.23,511.56,17.765555555555554]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["BCBS - BCBS STANDARD - HCPCS - J1953",27,62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0690",27,12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170",27,71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555551]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1170",27,71.055925925925905,71.055925925925905,0.23,511.56,17.765555555555554]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J1170",26,60.876538461538459,60.876538461538459,0.23,511.56,15.220769230769228]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1170",26,60.876538461538459,60.876538461538459,0.23,511.56,15.220769230769228]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J1170",26,72.546538461538475,72.546538461538475,0.23,511.56,18.138076923076927]
["MEDICARE - MEDICARE A&B - HCPCS - J1170",26,72.546538461538461,72.546538461538461,0.23,511.56,18.138076923076923]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J1170",26,72.546538461538475,72.546538461538475,0.23,511.56,18.138076923076923]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J3490",22,370.19727272727272,185.10045454545454,1.01,7444.48,92.551363636363646]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J3490",22,370.19727272727272,185.10045454545454,1.01,7444.48,92.551363636363646]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J3490",22,370.19727272727272,185.10045454545454,1.01,7444.48,92.551363636363646]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J2001",19,2.3747368421052628,2.3747368421052628,0.03,456.36,0.59315789473684211]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J2001",19,2.3747368421052637,2.3747368421052637,0.03,456.36,0.593157894736842]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2001",19,2.3747368421052637,2.3747368421052637,0.03,456.36,0.59315789473684188]
["WELLCARE - WELLCARE PPO - HCPCS - J1815",16,41.606249999999996,41.606249999999996,1.62,456.36,10.403749999999999]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J1580",16,40.20812500000001,17.186250000000001,0.79,456.36,10.052500000000002]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1580",16,40.20812500000001,40.20812500000001,0.79,456.36,10.052500000000002]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1815",16,41.60625000000001,17.781875000000003,1.62,456.36,10.40375]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1815",16,41.60625000000001,17.781874999999999,1.62,456.36,10.40375]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1815",16,41.606250000000003,420.34000000000009,1.62,456.36,10.403749999999999]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1815",16,41.60625000000001,41.60625000000001,1.62,456.36,10.403750000000002]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1580",16,40.208125000000003,17.186249999999998,0.79,456.36,10.0525]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J1815",16,41.606249999999996,17.781874999999996,1.62,456.36,10.40375]
["WELLCARE - WELLCARE HMO - HCPCS - J1580",16,40.208124999999988,40.208124999999988,0.79,456.36,10.052499999999998]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J1580",16,40.208124999999995,21.270624999999999,0.79,456.36,10.052500000000002]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1580",16,40.208124999999995,17.186250000000001,0.79,456.36,10.0525]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1815",16,41.606250000000003,420.34000000000009,1.62,456.36,10.403749999999999]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1815",16,41.606250000000003,22.010625000000001,1.62,456.36,10.40375]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1580",16,40.208125000000003,420.34000000000009,0.79,456.36,10.0525]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1815",16,41.606250000000003,16.641249999999999,1.62,456.36,10.403749999999999]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.052500000000002]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1815",16,41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1815",16,41.606250000000003,20.806249999999999,1.62,456.36,10.403749999999999]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J1815",16,41.606250000000003,41.606250000000003,1.62,456.36,10.40375]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999998]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["HSN DENTAL - HSN DENTAL - HCPCS - J1580",16,40.208124999999995,456.3599999999999,0.79,456.36,10.0525]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999998]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J1815",16,41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1580",16,40.208124999999988,40.208124999999988,0.79,456.36,10.052499999999998]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J1815",16,41.606249999999996,41.606249999999996,1.62,456.36,10.40375]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J1815",16,41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1815",16,41.606250000000003,456.3599999999999,1.62,456.36,10.40375]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J1815",16,41.606250000000003,23.432500000000005,1.62,456.36,10.403750000000002]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999998]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1815",16,41.606249999999996,41.606249999999996,1.62,456.36,10.40375]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J1580",16,40.208124999999995,420.34000000000009,0.79,456.36,10.052499999999998]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J1815",16,41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J1580",16,40.20812500000001,40.20812500000001,0.79,456.36,10.052500000000002]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1580",16,40.208124999999995,20.107499999999998,0.79,456.36,10.0525]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000004]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1580",16,40.208124999999995,420.34000000000009,0.79,456.36,10.0525]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1815",16,41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J1815",16,41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["BCBS - BCBS STANDARD - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["BCBS - BCBS PPO - HCPCS - J1580",16,40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J1580",16,40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J1815",16,41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["AETNA - AETNA HMO - HCPCS - J1580",16,40.208125000000003,21.270625000000003,0.79,456.36,10.052500000000002]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1815",16,41.606250000000003,38.462500000000006,1.62,456.36,10.403749999999999]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815",16,41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J1815",16,41.606250000000003,41.606250000000003,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J1815",16,41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2919",13,48.286923076923081,420.34000000000009,1.33,456.36,12.073076923076924]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2919",13,48.286923076923088,20.639230769230764,1.33,456.36,12.073076923076924]
["UNICARE - UNICARE STANDARD - HCPCS - J2919",13,48.286923076923067,36.214615384615385,1.33,456.36,12.073076923076922]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2919",13,48.286923076923081,25.542307692307695,1.33,456.36,12.073076923076922]
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["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2919",13,48.286923076923081,20.639230769230771,1.33,456.36,12.073076923076924]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2919",13,48.286923076923081,20.639230769230771,1.33,456.36,12.07307692307692]
["FALLON - FALLON POS STANDARD - HCPCS - J2919",13,48.286923076923067,24.14692307692307,1.33,456.36,12.07307692307692]
["HSN DENTAL - HSN DENTAL - HCPCS - J2919",13,48.286923076923088,456.35999999999996,1.33,456.36,12.073076923076924]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2919",13,48.286923076923067,27.193076923076926,1.33,456.36,12.073076923076922]
["TUFTS - TUFTS HMO - HCPCS - J2919",13,48.286923076923081,21.996923076923075,1.33,456.36,12.07307692307692]
["CIGNA - CIGNA STANDARD - HCPCS - J2919",13,48.286923076923088,41.043846153846161,1.33,456.36,12.073076923076922]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2919",13,48.286923076923095,48.286923076923095,1.33,456.36,12.073076923076924]
["AETNA - AETNA HMO - HCPCS - J2919",13,48.286923076923081,25.542307692307688,1.33,456.36,12.07307692307692]
["UNICARE - UNICARE STANDARD - HCPCS - J0736",12,30.712500000000002,7.919999999999999,1.9,456.36,7.6799999999999988]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J0736",12,30.712500000000002,7.6149999999999993,1.9,456.36,7.68]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J1815",12,43.631666666666661,43.631666666666661,1.62,456.36,10.909999999999998]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J0736",12,30.712500000000002,13.125,1.9,456.36,7.68]
["WELLCARE - WELLCARE STANDARD - HCPCS - J0736",12,30.712499999999995,7.9199999999999982,1.9,456.36,7.6799999999999988]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J0736",12,30.712500000000002,13.125,1.9,456.36,7.6799999999999988]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J0736",12,30.712500000000002,13.125,1.9,456.36,7.68]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J0736",12,30.712500000000002,7.6149999999999993,1.9,456.36,7.68]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J0736",12,30.712499999999995,7.6149999999999993,1.9,456.36,7.6799999999999988]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0736",12,30.712500000000006,420.34000000000009,1.9,456.36,7.6799999999999988]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J0736",12,30.712500000000002,30.712500000000002,1.9,456.36,7.68]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J0736",12,30.712500000000002,7.6150000000000011,1.9,456.36,7.68]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J0736",12,30.712500000000002,10.545833333333333,1.9,456.36,7.6799999999999988]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J0736",12,30.712500000000002,7.6150000000000011,1.9,456.36,7.6799999999999988]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J1815",12,43.631666666666661,43.631666666666661,1.62,456.36,10.909999999999998]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J0736",12,30.712500000000006,7.9983333333333322,1.9,456.36,7.6800000000000006]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J0736",12,30.712499999999995,8.3758333333333344,1.9,456.36,7.6799999999999988]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J1815",12,43.631666666666661,43.631666666666661,1.62,456.36,10.910000000000002]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0736",12,30.712499999999995,7.615000000000002,1.9,456.36,7.68]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J0736",12,30.712499999999995,7.6150000000000011,1.9,456.36,7.6799999999999988]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0736",12,30.712499999999991,30.712499999999991,1.9,456.36,7.6799999999999988]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J0736",12,30.712499999999995,420.34000000000009,1.9,456.36,7.6799999999999988]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J0736",12,30.712500000000006,7.9983333333333322,1.9,456.36,7.68]
["FALLON SCO - FALLON SCO HMO - HCPCS - J0736",12,30.712500000000002,7.615000000000002,1.9,456.36,7.68]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0736",12,30.712500000000002,420.34000000000009,1.9,456.36,7.68]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J0736",12,30.712500000000002,7.6149999999999993,1.9,456.36,7.68]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J0736",12,30.712500000000006,7.9983333333333322,1.9,456.36,7.68]
["HSN DENTAL - HSN DENTAL - HCPCS - J0736",12,30.712499999999995,456.35999999999996,1.9,456.36,7.6799999999999988]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J0736",12,30.712500000000006,7.9983333333333322,1.9,456.36,7.6799999999999988]
["HSN - HSN STANDARD - HCPCS - J0736",12,30.712499999999995,456.35999999999996,1.9,456.36,7.68]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0736",12,30.712500000000002,7.6150000000000011,1.9,456.36,7.68]
["AETNA - AETNA POS - HCPCS - J0736",12,30.712499999999995,16.245000000000001,1.9,456.36,7.68]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736",12,30.712500000000006,7.615000000000002,1.9,456.36,7.68]
["CCA - ZZZCCA STANDARD - HCPCS - J0736",12,30.712500000000006,7.9983333333333322,1.9,456.36,7.68]
["BCBS - BCBS SHIP PPO - HCPCS - J0736",12,30.712499999999995,9.08,1.9,456.36,7.6799999999999988]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2310",11,42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2310",11,42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2310",11,42.799090909090914,18.296363636363637,1.73,456.36,10.698181818181821]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2310",11,42.799090909090914,18.296363636363637,1.73,456.36,10.698181818181821]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2310",11,42.799090909090914,15.406363636363634,1.73,456.36,10.698181818181817]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2310",11,42.799090909090914,22.638181818181813,1.73,456.36,10.698181818181819]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181817]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2310",11,42.799090909090907,18.296363636363637,1.73,456.36,10.698181818181819]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2310",11,42.799090909090907,18.296363636363637,1.73,456.36,10.698181818181819]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2310",11,42.799090909090914,36.380909090909086,1.73,456.36,10.698181818181821]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2310",11,42.799090909090907,36.380909090909093,1.73,456.36,10.698181818181819]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2310",11,42.799090909090914,21.402727272727272,1.73,456.36,10.698181818181819]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181817]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["TUFTS - TUFTS PPO - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["HSN - HSN TEMPORARY - HCPCS - J2310",11,42.799090909090914,456.36,1.73,456.36,10.698181818181819]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181819]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2310",11,42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2310",11,42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181819]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2310",11,42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["BCBS - BCBS POS - HCPCS - J2310",11,42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["BCBS - BCBS PPO - HCPCS - J2310",11,42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["BCBS - BCBS SHIP PPO - HCPCS - J2310",11,42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J1561",10,3620.5279999999998,1915.261,83.55,7890.89,905.13300000000004]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1561",10,3620.5279999999998,1547.415,83.55,7890.89,905.13300000000004]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J1561",10,3620.5279999999998,1553.4479999999999,83.55,7890.89,905.13300000000004]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1561",10,3620.5279999999998,1547.415,83.55,7890.89,905.13300000000015]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J1561",10,3620.5279999999993,1547.4150000000002,83.55,7890.89,905.13300000000004]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J1561",10,3620.5279999999998,1553.4479999999996,83.55,7890.89,905.13300000000004]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1561",10,3620.5279999999998,1547.415,83.55,7890.89,905.13300000000004]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J1561",10,3620.5279999999998,420.34000000000003,83.55,7890.89,905.13300000000004]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J9041",10,5694.6600000000008,71.989999999999995,68.569999999999993,4840.46,1423.67]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J1561",10,3620.5279999999998,2039.0799999999995,83.55,7890.89,905.13299999999981]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1561",10,3620.5279999999998,420.34000000000003,83.55,7890.89,905.13300000000004]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1561",10,3620.5279999999998,1553.4480000000001,83.55,7890.89,905.13300000000015]
["TUFTS - TUFTS CARELINK - HCPCS - J1561",10,3620.5279999999998,1520.9479999999999,83.55,7890.89,905.13300000000004]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J1561",10,3620.5279999999993,1525.056,83.55,7890.89,905.13300000000015]
["BCBS - BCBS HMO - HCPCS - J1561",10,3620.5279999999998,1525.056,83.55,7890.89,905.13300000000015]
["AETNA - AETNA MCR SUPP - HCPCS - J1561",10,3620.5279999999998,1915.261,83.55,7890.89,905.13299999999981]
["UNICARE - UNICARE STANDARD - HCPCS - J7131",8,13.784999999999998,10.338749999999999,0.92,456.36,3.4462499999999996]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J7131",8,13.784999999999998,5.8937499999999998,0.92,456.36,3.4462499999999996]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J7131",8,13.784999999999998,5.8937499999999998,0.92,456.36,3.4462499999999996]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J7131",8,13.785,7.2912499999999998,0.92,456.36,3.44625]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J7131",8,13.785,13.785,0.92,456.36,3.44625]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J7131",8,13.785,5.8937499999999998,0.92,456.36,3.44625]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J7131",8,13.785,5.8937500000000007,0.92,456.36,3.44625]
["WELLCARE - WELLCARE STANDARD - HCPCS - J7131",8,13.785,13.785,0.92,456.36,3.44625]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J7131",8,13.785,13.785,0.92,456.36,3.44625]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J7131",8,13.785,7.2912499999999998,0.92,456.36,3.44625]
["UNITED - UNITED STANDARD - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["FALLON SCO - FALLON SCO HMO - HCPCS - J7131",8,13.785,13.785,0.92,456.36,3.44625]
["HSN - HSN STANDARD - HCPCS - J7131",8,13.785,456.36000000000007,0.92,456.36,3.44625]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7131",8,13.784999999999998,6.8924999999999992,0.92,456.36,3.4462499999999996]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J7131",8,13.785,13.785,0.92,456.36,3.44625]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J7131",8,13.785,13.785,0.92,456.36,3.44625]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J7131",8,13.785,420.34000000000003,0.92,456.36,3.44625]
["BCBS - BCBS PPO - HCPCS - J7131",8,13.784999999999998,9.02,0.92,456.36,3.4462499999999996]
["BCBS - BCBS POS - HCPCS - J7131",8,13.785,9.02,0.92,456.36,3.44625]
["CCA - CCA SCO ONECARE - HCPCS - J7131",8,13.785,13.785,0.92,456.36,3.44625]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J7131",8,13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J7131",8,13.785,7.2912499999999998,0.92,456.36,3.44625]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J0137",6,42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J0137",6,42.63,18.22,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0137",6,42.63,18.22,5.0999999999999996,456.36,10.659999999999998]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0137",6,42.63,420.34,5.0999999999999996,456.36,10.659999999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0137",6,42.63,420.34,5.0999999999999996,456.36,10.659999999999998]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0137",6,42.63,7.06,5.0999999999999996,456.36,10.659999999999998]
["WELLCARE - WELLCARE HMO - HCPCS - J0137",6,42.63,5.3,5.0999999999999996,456.36,10.659999999999998]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["UNICARE - UNICARE STANDARD - HCPCS - J0137",6,42.63,6,5.0999999999999996,456.36,10.659999999999998]
["UNITED - UNITED STANDARD - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["WELLCARE - WELLCARE PPO - HCPCS - J0137",6,42.63,5.3,5.0999999999999996,456.36,10.659999999999998]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J0137",6,42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J0137",6,42.63,6.12,5.0999999999999996,456.36,10.659999999999998]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0137",6,42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J0137",6,42.63,24.01,5.0999999999999996,456.36,10.659999999999998]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J0137",6,42.63,24.01,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J0137",6,42.63,5.61,5.0999999999999996,456.36,10.659999999999998]
["MEDICARE - MEDICARE A&B - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J0137",6,42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - Q9967",6,25.833333333333332,11.043333333333337,0.12,456.36,6.458333333333333]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["UNITED - UNITED STANDARD - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - Q9967",6,25.833333333333332,11.043333333333331,0.12,456.36,6.458333333333333]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J0137",6,42.63,7,5.0999999999999996,456.36,10.659999999999998]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - Q9967",6,25.833333333333332,21.958333333333329,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - Q9967",6,25.833333333333332,11.043333333333331,0.12,456.36,6.458333333333333]
["AETNA - AETNA MCR SUPP - HCPCS - J0137",6,42.63,22.55,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - Q9967",6,25.833333333333332,11.043333333333337,0.12,456.36,6.458333333333333]
["CCA - ZZZCCA STANDARD - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["UNITED - UNITED HP SHIP - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0137",6,42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J0137",6,42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["AETNA - AETNA MCR SUPP - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["FALLON - FALLON POS STANDARD - HCPCS - Q9967",6,25.833333333333332,12.916666666666666,0.12,456.36,6.458333333333333]
["BCBS - BCBS INDEMNITY - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["BCBS - BCBS STANDARD - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CCA - CCA SCO ONECARE - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["FALLON - FALLON HMO STANDARD - HCPCS - Q9967",6,25.833333333333332,12.916666666666666,0.12,456.36,6.458333333333333]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - Q9967",6,25.833333333333332,456.36000000000007,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - Q9967",6,25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J9041",5,5694.66,1905.3200000000002,68.569999999999993,4840.46,1423.67]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J9041",5,5694.66,94.94,68.569999999999993,4840.46,1423.67]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J9041",5,5694.66,2050.08,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J9041",5,5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J9041",5,5694.66,420.34,68.569999999999993,4840.46,1423.67]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["WELLCARE - WELLCARE PPO - HCPCS - J9041",5,5694.66,71.31,68.569999999999993,4840.46,1423.67]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J9041",5,5694.66,3207.23,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["HSN - HSN TEMPORARY - HCPCS - J9041",5,5694.66,456.36,68.569999999999993,4840.46,1423.67]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["TUFTS - TUFTS HMO - HCPCS - J9041",5,5694.66,884.68,68.569999999999993,4840.46,1423.67]
["TUFTS - TUFTS SPIRIT - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J9041",5,5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["FALLON - FALLON PPO STANDARD - HCPCS - J9041",5,5694.66,2847.33,68.569999999999993,4840.46,1423.67]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J9041",5,5694.66,456.36,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J9041",5,5694.66,72.45,68.569999999999993,4840.46,1423.67]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J9041",5,5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["AETNA - AETNA MCR SUPP - HCPCS - J9041",5,5694.66,1905.3200000000002,68.569999999999993,4840.46,1423.67]
["CCA - CCA SCO ONECARE - HCPCS - J9041",5,5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CIGNA - CIGNA CARELINK - HCPCS - J9041",5,5694.66,941.9,68.569999999999993,4840.46,1423.67]
["BCBS - BCBS STANDARD - HCPCS - J9041",5,5694.66,72.45,68.569999999999993,4840.46,1423.67]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - Q5114",4,5149.8999999999996,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - Q5114",4,5149.8999999999996,2201.0650000000005,420.34,5223.6099999999997,1287.4799999999998]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - Q5114",4,5149.9000000000005,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - Q5114",4,5149.9000000000005,2454.9250000000002,420.34,5223.6099999999997,1287.48]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - Q5114",4,5149.8999999999996,1792.8400000000001,420.34,5223.6099999999997,1287.4799999999998]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - Q5114",4,5149.9000000000005,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - Q5114",4,5149.8999999999996,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - Q5114",4,5149.8999999999996,2724.3,420.34,5223.6099999999997,1287.4799999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - Q5114",4,5149.9000000000005,420.34,420.34,5223.6099999999997,1287.48]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - Q5114",4,5149.9000000000005,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - Q5114",4,5149.8999999999996,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - Q5114",4,5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["WELLCARE - WELLCARE STANDARD - HCPCS - Q5114",4,5149.9000000000005,1674.9349999999999,420.34,5223.6099999999997,1287.48]
["FALLON SCO - FALLON SCO HMO - HCPCS - Q5114",4,5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - Q5114",4,5149.8999999999996,456.36,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - Q5114",4,5149.9000000000005,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - Q5114",4,5149.8999999999996,1610.5874999999999,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - Q5114",4,5149.8999999999996,1771.5625,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - Q5114",4,5149.9000000000005,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - Q5114",4,5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - Q5114",4,5149.8999999999996,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - Q5114",4,5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - Q5114",4,5149.8999999999996,2900.4225000000001,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - Q5114",4,5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - Q5114",4,5149.8999999999996,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - Q5114",4,5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["FALLON - FALLON POS STANDARD - HCPCS - Q5114",4,5149.9000000000005,2574.9500000000003,420.34,5223.6099999999997,1287.48]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - Q5114",4,5149.8999999999996,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["AETNA - AETNA MCR SUPP - HCPCS - Q5114",4,5149.8999999999996,2454.9250000000002,420.34,5223.6099999999997,1287.4799999999998]
["AETNA - AETNA PPO EPO - HCPCS - Q5114",4,5149.8999999999996,2454.9250000000002,420.34,5223.6099999999997,1287.4799999999998]
["BCBS - BCBS HMO - HCPCS - Q5114",4,5149.8999999999996,2269.9749999999999,420.34,5223.6099999999997,1287.48]
["CIGNA - CIGNA LOCALPLUS - HCPCS - Q5114",4,5149.8999999999996,4377.4174999999996,420.34,5223.6099999999997,1287.48]
["BCBS - BCBS SHIP PPO - HCPCS - Q5114",4,5149.9000000000005,2269.9749999999999,420.34,5223.6099999999997,1287.48]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J0750",3,210.53,89.98,1.22,456.36,52.63]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J0750",3,210.53,1.22,1.22,456.36,52.63]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J7121",3,15.396666666666667,5.5466666666666669,3.84,456.36,3.85]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["WELLCARE - WELLCARE STANDARD - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0750",3,210.53,420.34,1.22,456.36,52.63]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J7121",3,15.396666666666667,8.1466666666666665,3.84,456.36,3.85]
["UNICARE - UNICARE STANDARD - HCPCS - J7121",3,15.396666666666667,11.549999999999999,3.84,456.36,3.85]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J0750",3,210.53,111.37,1.22,456.36,52.63]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.85]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["UNITED - UNITED DEFINITY HRA - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J7121",3,15.396666666666667,8.1466666666666665,3.84,456.36,3.8499999999999996]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J7121",3,15.396666666666667,420.34,3.84,456.36,3.85]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.8499999999999996]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J7121",3,15.396666666666667,6.5799999999999992,3.84,456.36,3.85]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7121",3,15.396666666666667,7.7,3.84,456.36,3.8499999999999996]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["FALLON - FALLON HMO STANDARD - HCPCS - J0750",3,210.53,105.27,1.22,456.36,52.63]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["TUFTS - TUFTS CARELINK - HCPCS - J7121",3,15.396666666666667,9.5933333333333337,3.84,456.36,3.8499999999999996]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0750",3,210.53,1.22,1.22,456.36,52.63]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["TUFTS - TUFTS SELECT - HCPCS - J7121",3,15.396666666666667,9,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J7121",3,15.396666666666667,456.35999999999996,3.84,456.36,3.85]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J7121",3,15.396666666666667,11.623333333333333,3.84,456.36,3.8499999999999996]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["AETNA - AETNA MCR SUPP - HCPCS - J0750",3,210.53,111.37,1.22,456.36,52.63]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J7121",3,15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["BCBS - BCBS STANDARD - HCPCS - J7121",3,15.396666666666667,11.623333333333335,3.84,456.36,3.85]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J0750",3,210.53,1.37,1.22,456.36,52.63]
["BCBS - BCBS POS - HCPCS - J0750",3,210.53,1.37,1.22,456.36,52.63]
["CIGNA - CIGNA CARELINK - HCPCS - J0750",3,210.53,95.92,1.22,456.36,52.63]
["BCBS - BCBS STANDARD - HCPCS - J0750",3,210.53,1.37,1.22,456.36,52.63]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J0688",2,12.99,4.68,4.32,456.36,3.25]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J0688",2,12.99,420.34,4.32,456.36,3.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J0688",2,12.99,5.55,4.32,456.36,3.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J0688",2,12.99,5.2,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0688",2,12.99,420.34,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J0688",2,12.99,5.55,4.32,456.36,3.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J0688",2,12.99,5.55,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0688",2,12.99,420.34,4.32,456.36,3.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J0688",2,12.99,11.04,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["FALLON - FALLON POS STANDARD - HCPCS - J0688",2,12.99,6.5,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0688",2,12.99,420.34,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["MEDICARE - MEDICARE A&B - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["TUFTS - TUFTS PPO - HCPCS - J0688",2,12.99,5.92,4.32,456.36,3.25]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2270",2,31.34,16.579999999999998,11.28,456.36,7.84]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2270",2,31.34,13.39,11.28,456.36,7.84]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2270",2,31.34,16.579999999999998,11.28,456.36,7.84]
["CCA - ZZZCCA STANDARD - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2270",2,31.34,13.39,11.28,456.36,7.84]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2270",2,31.34,13.39,11.28,456.36,7.84]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2270",2,31.34,13.39,11.28,456.36,7.84]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2270",2,31.34,26.64,11.28,456.36,7.84]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0688",2,12.99,12.99,4.32,456.36,3.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2270",2,31.34,420.34,11.28,456.36,7.84]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2270",2,31.34,17.649999999999999,11.28,456.36,7.84]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["MEDICARE - MEDICARE A&B - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CIGNA - CIGNA CARELINK - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2270",2,31.34,17.649999999999999,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2598",2,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J8540",2,1,1,0.09,456.36,0.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J0702",2,126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1250",2,9,9,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J3301",2,15,15,0.98,456.36,3.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2270",2,31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2270",2,31.34,420.34,11.28,456.36,7.84]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J0131",1,42.63,22.55,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE HMO - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1817",1,67.430000000000007,35.67,24.27,456.36,16.86]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["UNITED - UNITED HP SHIP - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J2930",1,80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["UBH HPHC - UBH HPHC - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - S0020",1,6.93,420.34,2.4900000000000002,456.36,1.73]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1817",1,67.430000000000007,26.97,24.27,456.36,16.86]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["UNITED - UNITED HP SHIP - HCPCS - J7121",1,14.21,14.21,5.12,456.36,3.55]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2930",1,80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WELLCARE - WELLCARE HMO - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2930",1,80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1817",1,67.430000000000007,420.34,24.27,456.36,16.86]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J0131",1,42.63,36.24,5.0999999999999996,456.36,10.66]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J0131",1,42.63,18.22,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - C9113",1,17.77,420.34,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0131",1,42.63,18.22,5.0999999999999996,456.36,10.66]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J7121",1,14.21,14.21,5.12,456.36,3.55]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - S0020",1,6.93,5.89,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - C9113",1,17.77,7.59,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1817",1,67.430000000000007,28.82,24.27,456.36,16.86]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2930",1,80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J0131",1,42.63,36.24,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - C9113",1,17.77,7.59,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1817",1,67.430000000000007,57.32,24.27,456.36,16.86]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - S0020",1,6.93,5.89,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J0131",1,42.63,18.22,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE PPO - HCPCS - J0131",1,42.63,5.3,5.0999999999999996,456.36,10.66]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - S0020",1,6.93,420.34,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - S0020",1,6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["FALLON - FALLON POS STANDARD - HCPCS - C9113",1,17.77,8.89,6.4,456.36,4.4400000000000004]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - C9113",1,17.77,10.01,6.4,456.36,4.4400000000000004]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J7121",1,14.21,14.21,5.12,456.36,3.55]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J7121",1,14.21,14.21,5.12,456.36,3.55]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2930",1,80.260000000000005,456.36,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J1817",1,67.430000000000007,37.979999999999997,24.27,456.36,16.86]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["FALLON - FALLON POS STANDARD - HCPCS - J2930",1,80.260000000000005,40.130000000000003,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["FALLON SCO - FALLON SCO HMO - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["TUFTS - TUFTS SPIRIT - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J7121",1,14.21,14.21,5.12,456.36,3.55]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - S0020",1,6.93,456.36,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["TUFTS - TUFTS CARELINK - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - S0020",1,6.93,3.9,2.4900000000000002,456.36,1.73]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2930",1,80.260000000000005,456.36,24.44,456.36,20.07]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - C9113",1,17.77,456.36,6.4,456.36,4.4400000000000004]
["TUFTS - TUFTS SELECT - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["TUFTS - TUFTS SPIRIT - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J7131",1,2.56,2.56,0.92,456.36,0.64]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CIGNA - CIGNA STANDARD - HCPCS - S0020",1,6.93,5.89,2.4900000000000002,456.36,1.73]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1250",1,9,4.76,3.24,456.36,2.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J3010",1,0.52,0.28000000000000003,0.19,456.36,0.13]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J7307",1,3163,1673.23,420.34,2688.55,790.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1250",1,9,3.85,3.24,456.36,2.25]
["CCA - CCA SCO STANDARD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["BCBS - BCBS INDEMNITY - HCPCS - S0020",1,6.93,4.4800000000000004,2.4900000000000002,456.36,1.73]
["BCBS - BCBS PPO - HCPCS - S0020",1,6.93,4.4800000000000004,2.4900000000000002,456.36,1.73]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CIGNA - CIGNA LOCALPLUS - HCPCS - S0020",1,6.93,5.89,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J3301",1,15,6.41,0.98,456.36,3.75]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2598",1,150.99,128.34,36.299999999999997,456.36,37.75]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J7307",1,3163,2688.55,420.34,2688.55,790.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1250",1,9,4.0999999999999996,3.24,456.36,2.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J0131",1,42.63,7,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - A9576",1,5,4.25,1.58,456.36,1.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - Q0249",1,9,3.85,3.24,456.36,2.25]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1250",1,9,3.85,3.24,456.36,2.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J7307",1,3163,2688.55,420.34,2688.55,790.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J7307",1,3163,1673.23,420.34,2688.55,790.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J3301",1,15,6.41,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - Q0249",1,9,3.85,3.24,456.36,2.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["BCBS - BCBS POS - HCPCS - J2930",1,80.260000000000005,34.64,24.44,456.36,20.07]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J7307",1,3163,1114.33,420.34,2688.55,790.75]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - A9576",1,5,2.14,1.58,456.36,1.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["WELLCARE - WELLCARE PPO - HCPCS - C9257",1,35,1.93,1.68,456.36,8.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J3590",1,1218,520.57000000000005,420.34,1218,304.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J3590",1,1218,520.57000000000005,420.34,1218,304.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3590",1,1218,644.32000000000005,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - Q0249",1,9,4.76,3.24,456.36,2.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1250",1,9,3.85,3.24,456.36,2.25]
["CIGNA - CIGNA CARELINK - HCPCS - J0131",1,42.63,42.63,5.0999999999999996,456.36,10.66]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J7608",1,13.24,6.83,4.7699999999999996,456.36,3.31]
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["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2598",1,150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3590",1,1218,644.32000000000005,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J7307",1,3163,1114.33,420.34,2688.55,790.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS - BCBS PPO - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J7608",1,13.24,5.66,4.7699999999999996,456.36,3.31]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["BCBS - BCBS SHIP PPO - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["UNICARE - UNICARE STANDARD - HCPCS - A9576",1,5,1.58,1.58,456.36,1.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J3301",1,15,6.41,0.98,456.36,3.75]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J7608",1,13.24,5.3,4.7699999999999996,456.36,3.31]
["UNICARE - UNICARE STANDARD - HCPCS - J3590",1,1218,913.5,420.34,1218,304.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - P9047",1,187,79.92,50.13,456.36,46.75]
["WELLCARE - WELLCARE HMO - HCPCS - J2598",1,150.99,37.75,36.299999999999997,456.36,37.75]
["WELLCARE - WELLCARE HMO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE PPO - HCPCS - J2598",1,150.99,37.75,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3010",1,0.52,0.22,0.19,456.36,0.13]
["UNITED - UNITED DEFINITY HRA - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["UNITED - UNITED HP SHIP - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3590",1,1218,520.57000000000005,420.34,1218,304.5]
["AETNA - AETNA HMO - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J7608",1,13.24,4.7699999999999996,4.7699999999999996,456.36,3.31]
["UNITED - UNITED HP SHIP - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["AETNA - AETNA HMO - HCPCS - J2930",1,80.260000000000005,42.46,24.44,456.36,20.07]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["AETNA - AETNA HMO - HCPCS - S0020",1,6.93,3.67,2.4900000000000002,456.36,1.73]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["CCA - CCA SCO ONECARE - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["AETNA - AETNA POS - HCPCS - C9113",1,17.77,9.4,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CCA - ZZZCCA STANDARD - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED - UNITED NAVIGATE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["UNITED - UNITED NAVIGATE - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - C9113",1,17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3301",1,15,7.94,0.98,456.36,3.75]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J0583",1,266.44,113.88,55,456.36,66.61]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J3301",1,15,6.41,0.98,456.36,3.75]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J0131",1,42.63,5.36,5.0999999999999996,456.36,10.66]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J3301",1,15,6.41,0.98,456.36,3.75]
["AETNA - AETNA PPO EPO - HCPCS - S0020",1,6.93,3.67,2.4900000000000002,456.36,1.73]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J1817",1,67.430000000000007,35.67,24.27,456.36,16.86]
["UNITED - UNITED STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J8540",1,1,0.11,0.09,456.36,0.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0131",1,42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J8540",1,1,0.43,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - C9257",1,35,14.96,1.68,456.36,8.75]
["ZZZAETNA - ZZZAETNA POS - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3301",1,15,7.94,0.98,456.36,3.75]
["BCBS - BCBS HMO - HCPCS - J1817",1,67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2930",1,80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - S0020",1,6.93,6.93,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J7307",1,3163,1351.87,420.34,2688.55,790.75]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J0702",1,126,53.85,7.07,456.36,31.5]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J3590",1,1218,520.57000000000005,420.34,1218,304.5]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["UNITED - UNITED NAVIGATE - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["UNITED - UNITED NAVIGATE - HCPCS - Q0249",1,9,9,3.24,456.36,2.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS - TUFTS PPO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J7608",1,13.24,9.36,4.7699999999999996,456.36,3.31]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2598",1,150.99,85.04,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["AETNA - AETNA POS - HCPCS - J3010",1,0.52,0.28000000000000003,0.19,456.36,0.13]
["HSN DENTAL - HSN DENTAL - HCPCS - J0702",1,126,456.36,7.07,456.36,31.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2598",1,150.99,85.04,36.299999999999997,456.36,37.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["BCBS - BCBS HMO - HCPCS - J2598",1,150.99,37.6,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS SELECT - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J7608",1,13.24,9.36,4.7699999999999996,456.36,3.31]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CCA - CCA SCO ONECARE - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["CCA - CCA SCO ONECARE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CCA - CCA SCO ONECARE - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J7608",1,13.24,456.36,4.7699999999999996,456.36,3.31]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["CCA - CCA SCO STANDARD - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS - TUFTS HMO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CCA - ZZZCCA STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CCA - ZZZCCA STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2598",1,150.99,50.26,36.299999999999997,456.36,37.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J7608",1,13.24,6.83,4.7699999999999996,456.36,3.31]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J7608",1,13.24,6.83,4.7699999999999996,456.36,3.31]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HSN - HSN TEMPORARY - HCPCS - J3010",1,0.52,456.36,0.19,456.36,0.13]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J3010",1,0.52,456.36,0.19,456.36,0.13]
["CIGNA - CIGNA CARELINK - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CIGNA - CIGNA CARELINK - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CIGNA - CIGNA CARELINK - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J7307",1,3163,1781.4,420.34,2688.55,790.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J1250",1,9,7.65,3.24,456.36,2.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["CIGNA - CIGNA LOCALPLUS - HCPCS - Q0249",1,9,7.65,3.24,456.36,2.25]
["CIGNA - CIGNA STANDARD - HCPCS - J0583",1,266.44,226.47,55,456.36,66.61]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CIGNA - CIGNA STANDARD - HCPCS - J3301",1,15,12.75,0.98,456.36,3.75]
["CIGNA - CIGNA STANDARD - HCPCS - J3590",1,1218,1035.3,420.34,1218,304.5]
["CIGNA - CIGNA STANDARD - HCPCS - J8540",1,1,0.85,0.09,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J3301",1,15,7.94,0.98,456.36,3.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J7307",1,3163,1673.23,420.34,2688.55,790.75]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS - BCBS HMO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2598",1,150.99,37.6,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS - BCBS STANDARD - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["BCBS - BCBS INDEMNITY - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J7608",1,13.24,6.83,4.7699999999999996,456.36,3.31]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HSN - HSN TEMPORARY - HCPCS - C9257",1,35,456.36,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["HSN DENTAL - HSN DENTAL - HCPCS - P9047",1,187,456.36,50.13,456.36,46.75]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - Q0249",1,9,5.81,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - P9047",1,187,456.36,50.13,456.36,46.75]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J3301",1,15,8.4499999999999993,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J1250",1,9,5.07,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - P9047",1,187,138.30000000000001,50.13,456.36,46.75]
["BCBS - BCBS HMO - HCPCS - C9257",1,35,2.27,1.68,456.36,8.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["BCBS - BCBS INDEMNITY - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS HMO - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS POS - HCPCS - J7307",1,3163,1119.79,420.34,2688.55,790.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS SELECT - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS SELECT - HCPCS - J2598",1,150.99,150.99,36.299999999999997,456.36,37.75]
["BCBS - BCBS POS - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3590",1,1218,420.34,420.34,1218,304.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["BCBS - BCBS POS - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - HCPCS - P9047",1,187,98.92,50.13,456.36,46.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - P9047",1,187,58.38,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - P9047",1,187,420.34,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["FALLON SCO - FALLON SCO HMO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["BCBS - BCBS STANDARD - HCPCS - Q0249",1,9,5.81,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - Q0249",1,9,6.77,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J7608",1,13.24,6.83,4.7699999999999996,456.36,3.31]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - C9257",1,35,2.0299999999999998,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J7608",1,13.24,6.83,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["HSN - HSN STANDARD - HCPCS - A9576",1,5,456.36,1.58,456.36,1.25]
["HSN - HSN STANDARD - HCPCS - J3301",1,15,456.36,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["HSN - HSN TEMPORARY - HCPCS - J1250",1,9,456.36,3.24,456.36,2.25]
["HSN - HSN TEMPORARY - HCPCS - J3301",1,15,456.36,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J1250",1,9,456.36,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["HSN DENTAL - HSN DENTAL - HCPCS - J8540",1,1,456.36,0.09,456.36,0.25]
["AETNA - AETNA HMO - HCPCS - J3301",1,15,7.94,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J0583",1,266.44,456.36,55,456.36,66.61]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J3301",1,15,456.36,0.98,456.36,3.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - Q0249",1,9,456.36,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["AETNA - AETNA PPO EPO - HCPCS - C9257",1,35,18.52,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AETNA - AETNA HMO - HCPCS - J7307",1,3163,1673.23,420.34,2688.55,790.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J3010",1,0.52,0.28999999999999998,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J7608",1,13.24,7.46,4.7699999999999996,456.36,3.31]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J0702",1,126,70.959999999999994,7.07,456.36,31.5]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J3010",1,0.52,0.28999999999999998,0.19,456.36,0.13]
["AETNA - AETNA HMO - HCPCS - J8540",1,1,0.11,0.09,456.36,0.25]
["MEDICARE - MEDICARE A&B - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["MEDICARE - MEDICARE A&B - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["AETNA - AETNA HMO - HCPCS - Q0249",1,9,4.76,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - C9257",1,35,1.68,1.68,456.36,8.75]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - P9047",1,187,50.13,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["BCBS - BCBS HMO - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS CARELINK - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS - TUFTS HMO - HCPCS - J7608",1,13.24,7.57,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS POS - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS - TUFTS POS - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS - TUFTS POS - HCPCS - J7608",1,13.24,7.57,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS - TUFTS POS - HCPCS - P9047",1,187,53.76,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J1250",1,9,4.76,3.24,456.36,2.25]
["AETNA - AETNA MCR SUPP - HCPCS - J1250",1,9,4.76,3.24,456.36,2.25]
["TUFTS - TUFTS PPO - HCPCS - C9257",1,35,13.1,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS - TUFTS PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS - TUFTS PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS - TUFTS PPO - HCPCS - J7608",1,13.24,8.06,4.7699999999999996,456.36,3.31]
["BCBS - BCBS STANDARD - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS PPO - HCPCS - P9047",1,187,57.24,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS - TUFTS SELECT - HCPCS - C9257",1,35,12,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS - TUFTS SELECT - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS - TUFTS SELECT - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["TUFTS - TUFTS SELECT - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["BCBS - BCBS STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS - TUFTS SELECT - HCPCS - J7608",1,13.24,7.39,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS - TUFTS SELECT - HCPCS - P9047",1,187,52.45,50.13,456.36,46.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - C9257",1,35,1.94,1.68,456.36,8.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2598",1,150.99,79.87,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS SPIRIT - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS - TUFTS SPIRIT - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["BCBS - BCBS STANDARD - HCPCS - J1250",1,9,5.81,3.24,456.36,2.25]
["TUFTS - TUFTS SPIRIT - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2598",1,150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS SPIRIT - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS - TUFTS SPIRIT - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["AETNA - AETNA MCR SUPP - HCPCS - J2598",1,150.99,79.87,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - A9576",1,5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - C9257",1,35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0583",1,266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0702",1,126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1250",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2598",1,150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3010",1,0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - Q0249",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["AETNA - AETNA MCR SUPP - HCPCS - J3010",1,0.52,0.28000000000000003,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["FALLON - FALLON HMO STANDARD - HCPCS - A9576",1,5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON HMO STANDARD - HCPCS - C9257",1,35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J0583",1,266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J0702",1,126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J1250",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["BCBS - BCBS STANDARD - HCPCS - J2598",1,150.99,37.6,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J2598",1,150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2598",1,150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J3010",1,0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J3301",1,15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J7608",1,13.24,7,4.7699999999999996,456.36,3.31]
["FALLON - FALLON HMO STANDARD - HCPCS - J7307",1,3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - C9257",1,35,420.34,1.68,456.36,8.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J7608",1,13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J0702",1,126,420.34,7.07,456.36,31.5]
["FALLON - FALLON HMO STANDARD - HCPCS - J8540",1,1,0.5,0.09,456.36,0.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["FALLON - FALLON HMO STANDARD - HCPCS - P9047",1,187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3010",1,0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON HMO STANDARD - HCPCS - Q0249",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3590",1,1218,420.34,420.34,1218,304.5]
["AETNA - AETNA MCR SUPP - HCPCS - J3301",1,15,7.94,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J7608",1,13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON POS STANDARD - HCPCS - A9576",1,5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - P9047",1,187,420.34,50.13,456.36,46.75]
["FALLON - FALLON POS STANDARD - HCPCS - C9257",1,35,17.5,1.68,456.36,8.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J8540",1,1,0.53,0.09,456.36,0.25]
["FALLON - FALLON POS STANDARD - HCPCS - J0583",1,266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - C9257",1,35,2.56,1.68,456.36,8.75]
["FALLON - FALLON POS STANDARD - HCPCS - J0702",1,126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["FALLON - FALLON POS STANDARD - HCPCS - J1250",1,9,4.5,3.24,456.36,2.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J1250",1,9,5.81,3.24,456.36,2.25]
["BCBS - BCBS STANDARD - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["FALLON - FALLON POS STANDARD - HCPCS - J2598",1,150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["FALLON - FALLON POS STANDARD - HCPCS - J3010",1,0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - P9047",1,187,73.5,50.13,456.36,46.75]
["FALLON - FALLON POS STANDARD - HCPCS - J3301",1,15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["FALLON - FALLON POS STANDARD - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["FALLON - FALLON POS STANDARD - HCPCS - J7307",1,3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON POS STANDARD - HCPCS - J7608",1,13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON - FALLON POS STANDARD - HCPCS - J8540",1,1,0.5,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["FALLON - FALLON POS STANDARD - HCPCS - P9047",1,187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON POS STANDARD - HCPCS - Q0249",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - HCPCS - J3590",1,1218,644.32000000000005,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["FALLON - FALLON PPO STANDARD - HCPCS - A9576",1,5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["FALLON - FALLON PPO STANDARD - HCPCS - C9257",1,35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["FALLON - FALLON PPO STANDARD - HCPCS - J0583",1,266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["FALLON - FALLON PPO STANDARD - HCPCS - J0702",1,126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2598",1,150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON - FALLON PPO STANDARD - HCPCS - J1250",1,9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS - BCBS STANDARD - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["FALLON - FALLON PPO STANDARD - HCPCS - J2598",1,150.99,75.5,36.299999999999997,456.36,37.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J3010",1,0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - C9257",1,35,420.34,1.68,456.36,8.75]
["FALLON - FALLON PPO STANDARD - HCPCS - J3301",1,15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0702",1,126,420.34,7.07,456.36,31.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["FALLON - FALLON PPO STANDARD - HCPCS - J7307",1,3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3010",1,0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON PPO STANDARD - HCPCS - J7608",1,13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3590",1,1218,420.34,420.34,1218,304.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J8540",1,1,0.5,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J7608",1,13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON PPO STANDARD - HCPCS - P9047",1,187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - P9047",1,187,420.34,50.13,456.36,46.75]
["FALLON - FALLON PPO STANDARD - HCPCS - Q0249",1,9,4.5,3.24,456.36,2.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["AETNA - AETNA MCR SUPP - HCPCS - J7307",1,3163,1673.23,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - C9257",1,35,2.56,1.68,456.36,8.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - P9047",1,187,73.5,50.13,456.36,46.75]
["BCBS - BCBS STANDARD - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - A9576",1,5,420.34,1.58,456.36,1.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0583",1,266.44,420.34,55,456.36,66.61]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1250",1,9,420.34,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2598",1,150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J3301",1,15,420.34,0.98,456.36,3.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J7307",1,3163,420.34,420.34,2688.55,790.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - P9047",1,187,53.08,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J8540",1,1,420.34,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - HCPCS - J7608",1,13.24,7,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - Q0249",1,9,420.34,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - C9257",1,35,1.85,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0583",1,266.44,266.44,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2598",1,150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1250",1,9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["BCBS - BCBS STANDARD - HCPCS - J7307",1,3163,1318.16,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2598",1,150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0702",1,126,126,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3010",1,0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - C9257",1,35,420.34,1.68,456.36,8.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3301",1,15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0702",1,126,420.34,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3590",1,1218,1218,420.34,1218,304.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3301",1,15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3010",1,0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3590",1,1218,609,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3590",1,1218,420.34,420.34,1218,304.5]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7307",1,3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J7608",1,13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7608",1,13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - P9047",1,187,420.34,50.13,456.36,46.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J8540",1,1,0.5,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - P9047",1,187,93.5,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J8540",1,1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - A9576",1,5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - P9047",1,187,55.73,50.13,456.36,46.75]

{"sheet":"Average Table - HCPCS","index":22,"n_rows":7726,"n_cols":13,"rows_kept":2250,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
["Payer - Plan - Bill Type - Bill Code","Payer - Plan -Bill Code - Description","Payer","Plan","Bill Type","Bill Code","Bill Code Description ","HCPCS & Description","Gross Charge Amount","Payer Charge Amount","Minimum Charge Amount","Maximum Charge Amount","Self-Pay Charge"]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2001","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196133,4.1013725490196133,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2001","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196125,4.1013725490196125,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J3490","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042518,454.52787234042518,0.41,7676.82,113.63319148936165]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J3490","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2704","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J2704","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J0690","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032263,12.164516129032263,0.17,456.36,3.0412903225806467]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J0690","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1953","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666641,62.176666666666641,3.5,456.36,15.54555555555555]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1170","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925976,71.055925925925976,0.23,511.56,17.765555555555558]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1170","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925976,71.055925925925976,0.23,511.56,17.765555555555562]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1953","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2001","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.1713725490196083,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2001","WORKERS COMP - WORKERS COMP MBTA - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J2001","WORKERS COMP - WORKERS COMP CCMSI - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960793,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470591]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2001","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J2001 - PR LIDOCAINE INJECTION","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2001","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2001","WORKERS COMP - WORKERS COMP THE HARTFORD - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470587]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J2001","ZZZAETNA - ZZZAETNA HMO - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.1713725490196079,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2001","ZZZCIGNA - CIGNA LOCALPLUS - J2001 - PR LIDOCAINE INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,3.4850980392156861,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2001","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470591]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2001","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J2001","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960793,0.03,456.36,1.0252941176470587]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2001","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.753725490196079,0.03,456.36,1.0252941176470587]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP AIG - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470589]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2001","TUFTS MEDICARE - TUFTS MEDICARE HMO - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470591]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470589]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2001","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J2001","ZZZAETNA - ZZZAETNA POS - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.1713725490196083,0.03,456.36,1.0252941176470589]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J2001","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2001","ZZZCCA ONECARE - ZZZCCA ONECARE - J2001 - PR LIDOCAINE INJECTION","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J2001","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2001","ZZZCIGNA - ZZZCIGNA STANDARD - J2001 - PR LIDOCAINE INJECTION","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,3.4850980392156852,0.03,456.36,1.0252941176470591]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2001","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2001","ZZZUNITED - ZZZUNITED DEFINITY HRA - J2001 - PR LIDOCAINE INJECTION","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2001","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J2001 - PR LIDOCAINE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2001","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,1.753725490196079,0.03,456.36,1.0252941176470589]
["UBH HPHC - UBH HPHC - HCPCS - J2001","UBH HPHC - UBH HPHC - J2001 - PR LIDOCAINE INJECTION","UBH HPHC","UBH HPHC","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J2001","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,1.7537254901960784,0.03,456.36,1.0252941176470591]
["UNICARE - UNICARE STANDARD - HCPCS - J2001","UNICARE - UNICARE STANDARD - J2001 - PR LIDOCAINE INJECTION","UNICARE","UNICARE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.6647058823529424,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2001","WORKERS COMP - WORKERS COMP COVE RISK - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["UNITED - UNITED DEFINITY HRA - HCPCS - J2001","UNITED - UNITED DEFINITY HRA - J2001 - PR LIDOCAINE INJECTION","UNITED","UNITED DEFINITY HRA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J2001","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960784,0.03,456.36,1.0252941176470589]
["UNITED - UNITED NAVIGATE - HCPCS - J2001","UNITED - UNITED NAVIGATE - J2001 - PR LIDOCAINE INJECTION","UNITED","UNITED NAVIGATE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J2001","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.753725490196079,0.03,456.36,1.0252941176470587]
["UNITED - UNITED STANDARD - HCPCS - J2001","UNITED - UNITED STANDARD - J2001 - PR LIDOCAINE INJECTION","UNITED","UNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2001","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960784,0.03,456.36,1.0252941176470591]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J2001","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J2001 - PR LIDOCAINE INJECTION","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2001","WORKERS COMP - WORKERS COMP STANDARD - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960786,0.03,456.36,1.0252941176470589]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J2001","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J2001 - PR LIDOCAINE INJECTION","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2001","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.753725490196079,0.03,456.36,1.0252941176470591]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J2001","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J2001 - PR LIDOCAINE INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470594]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960786,0.03,456.36,1.0252941176470591]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2001","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J2001 - PR LIDOCAINE INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.7537254901960784,0.03,456.36,1.0252941176470589]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J2001","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J2001 - PR LIDOCAINE INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2001","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.753725490196079,0.03,456.36,1.0252941176470591]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J2001","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J2001 - PR LIDOCAINE INJECTION","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2001","ZZZAETNA - ZZZAETNA MCR SUPP - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.1713725490196083,0.03,456.36,1.0252941176470589]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J2001","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J2001 - PR LIDOCAINE INJECTION","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2001","ZZZAETNA - ZZZAETNA PPO-EPO - J2001 - PR LIDOCAINE INJECTION","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.1713725490196079,0.03,456.36,1.0252941176470589]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J2001","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J2001 - PR LIDOCAINE INJECTION","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.6384313725490203,0.03,456.36,1.0252941176470591]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J2001","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J2001 - PR LIDOCAINE INJECTION","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,1.753725490196079,0.03,456.36,1.0252941176470591]
["WELLCARE - WELLCARE HMO - HCPCS - J2001","WELLCARE - WELLCARE HMO - J2001 - PR LIDOCAINE INJECTION","WELLCARE","WELLCARE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470587]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J2001","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J2001 - PR LIDOCAINE INJECTION","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WELLCARE - WELLCARE PPO - HCPCS - J2001","WELLCARE - WELLCARE PPO - J2001 - PR LIDOCAINE INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2001","ZZZCIGNA - ZZZCIGNA CARELINK - J2001 - PR LIDOCAINE INJECTION","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470587]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2001","WELLCARE - WELLCARE STANDARD - J2001 - PR LIDOCAINE INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2001","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J2001 - PR LIDOCAINE INJECTION","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2001","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J2001 - PR LIDOCAINE INJECTION","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.4776470588235289,0.03,456.36,1.0252941176470591]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J2001","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - J2001 - PR LIDOCAINE INJECTION","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2001","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J2001 - PR LIDOCAINE INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2001","ZZZUNITED - ZZZUNITED STANDARD - J2001 - PR LIDOCAINE INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J2001","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J2001 - PR LIDOCAINE INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J2001","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J2001 - PR LIDOCAINE INJECTION","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,1.7537254901960784,0.03,456.36,1.0252941176470589]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2001","FALLON SCO - FALLON SCO HMO - J2001 - PR LIDOCAINE INJECTION","FALLON SCO","FALLON SCO HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2001","HSN PARTIAL - HSN PARTIAL TEMPORARY - J2001 - PR LIDOCAINE INJECTION","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,456.3600000000003,0.03,456.36,1.0252941176470587]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2001","CORRECTIONS - CORRECTIONS MIDDLESEX - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["FALLON - FALLON PPO STANDARD - HCPCS - J2001","FALLON - FALLON PPO STANDARD - J2001 - PR LIDOCAINE INJECTION","FALLON","FALLON PPO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.0545098039215683,0.03,456.36,1.0252941176470585]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2001","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2001","HSN BAD DEBT - HSN BAD DEBT - J2001 - PR LIDOCAINE INJECTION","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2001","CORRECTIONS - CORRECTIONS PLYMOUTH - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS POS - HCPCS - J2001","TUFTS - TUFTS POS - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.35,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2001","CORRECTIONS - CORRECTIONS NORFOLK - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["FALLON - FALLON HMO STANDARD - HCPCS - J2001","FALLON - FALLON HMO STANDARD - J2001 - PR LIDOCAINE INJECTION","FALLON","FALLON HMO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.0545098039215688,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2001","CORRECTIONS - CORRECTIONS NASHUA - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2001","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J2001 - PR LIDOCAINE INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J2001 - PR LIDOCAINE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.3109803921568632,0.03,456.36,1.0252941176470589]
["HSN - HSN STANDARD - HCPCS - J2001","HSN - HSN STANDARD - J2001 - PR LIDOCAINE INJECTION","HSN","HSN STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J2001 - PR LIDOCAINE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.3109803921568628,0.03,456.36,1.0252941176470587]
["HSN DENTAL - HSN DENTAL - HCPCS - J2001","HSN DENTAL - HSN DENTAL - J2001 - PR LIDOCAINE INJECTION","HSN DENTAL","HSN DENTAL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470591]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J2001","MEDICARE - MEDICARE PART B ONLY - J2001 - PR LIDOCAINE INJECTION","MEDICARE","MEDICARE PART B ONLY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2001","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2001","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J2001 - PR LIDOCAINE INJECTION","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["MEDICARE - MEDICARE A&B - HCPCS - J2001","MEDICARE - MEDICARE A&B - J2001 - PR LIDOCAINE INJECTION","MEDICARE","MEDICARE A&B","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2001","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2001","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J2001 - PR LIDOCAINE INJECTION","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2001","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J2001 - PR LIDOCAINE INJECTION","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2001","CORRECTIONS - CORRECTIONS NAPHCARE - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2001","TRICARE EAST - TRICARE EAST SELECT - J2001 - PR LIDOCAINE INJECTION","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS CARELINK - HCPCS - J2001","TUFTS - TUFTS CARELINK - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS CARELINK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470587]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS SELECT - HCPCS - J2001","TUFTS - TUFTS SELECT - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS SELECT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.1700000000000008,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2001","CORRECTIONS - CORRECTIONS ICE INMATE - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2001","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2001","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2001","FALLON - FALLON COMMUNITY PLAN - J2001 - PR LIDOCAINE INJECTION","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.0545098039215688,0.03,456.36,1.0252941176470587]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470594]
["FALLON - FALLON POS STANDARD - HCPCS - J2001","FALLON - FALLON POS STANDARD - J2001 - PR LIDOCAINE INJECTION","FALLON","FALLON POS STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.0545098039215679,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2001","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J2001 - PR LIDOCAINE INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J2001","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J2001 - PR LIDOCAINE INJECTION","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2001","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J2001 - PR LIDOCAINE INJECTION","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HSN - HSN TEMPORARY - HCPCS - J2001","HSN - HSN TEMPORARY - J2001 - PR LIDOCAINE INJECTION","HSN","HSN TEMPORARY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS CEDAR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2001","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J2001 - PR LIDOCAINE INJECTION","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS CONCORD - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2001","HSN PARTIAL - HSN PARTIAL STANDARD - J2001 - PR LIDOCAINE INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,456.3600000000003,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2001","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J2001 - PR LIDOCAINE INJECTION","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS GARDNER - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J2001 - PR LIDOCAINE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.3109803921568628,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2001","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J2001 - PR LIDOCAINE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.3109803921568628,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2001","MEDICARE - MEDICARE PART A ONLY - J2001 - PR LIDOCAINE INJECTION","MEDICARE","MEDICARE PART A ONLY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470594]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2001","MEDICARE - RAILROAD MEDICARE  RAILROAD - J2001 - PR LIDOCAINE INJECTION","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2001","OXFORD HEALTH - OXFORD HEALTH STANDARD - J2001 - PR LIDOCAINE INJECTION","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2001","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J2001 - PR LIDOCAINE INJECTION","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2001","TRICARE EAST - TRICARE EAST PRIME (HMO) - J2001 - PR LIDOCAINE INJECTION","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS NASHUA - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J2001","TRICARE FOR LIFE - TRICARE FOR LIFE - J2001 - PR LIDOCAINE INJECTION","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470585]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS HMO - HCPCS - J2001","TUFTS - TUFTS HMO - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["TUFTS - TUFTS PPO - HCPCS - J2001","TUFTS - TUFTS PPO - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.3500000000000005,0.03,456.36,1.0252941176470591]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["TUFTS - TUFTS SPIRIT - HCPCS - J2001","TUFTS - TUFTS SPIRIT - J2001 - PR LIDOCAINE INJECTION","TUFTS","TUFTS SPIRIT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470585]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2001","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470587]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2001","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J2001 - PR LIDOCAINE INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,420.34000000000009,0.03,456.36,1.0252941176470591]
["CIGNA - CIGNA CARELINK - HCPCS - J2001","CIGNA - CIGNA CARELINK - J2001 - PR LIDOCAINE INJECTION","CIGNA","CIGNA CARELINK","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.35,0.03,456.36,1.0252941176470589]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J2001 - PR LIDOCAINE INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2001","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2001","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J2001 - PR LIDOCAINE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["CCA - ZZZCCA STANDARD - HCPCS - J2001","CCA - ZZZCCA STANDARD - J2001 - PR LIDOCAINE INJECTION","CCA","ZZZCCA STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J2001 - PR LIDOCAINE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2001","CORRECTIONS - CORRECTIONS BRISTOL - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J2001 - PR LIDOCAINE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470591]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J2001 - PR LIDOCAINE INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.9639215686274518,0.03,456.36,1.0252941176470591]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2001","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J2001 - PR LIDOCAINE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["CCA - CCA SCO ONECARE - HCPCS - J2001","CCA - CCA SCO ONECARE - J2001 - PR LIDOCAINE INJECTION","CCA","CCA SCO ONECARE","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["AETNA - AETNA HMO - HCPCS - J2001","AETNA - AETNA HMO - J2001 - PR LIDOCAINE INJECTION","AETNA","AETNA HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.1713725490196074,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2001","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J2001 - PR LIDOCAINE INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["AETNA - AETNA MCR SUPP - HCPCS - J2001","AETNA - AETNA MCR SUPP - J2001 - PR LIDOCAINE INJECTION","AETNA","AETNA MCR SUPP","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.1713725490196087,0.03,456.36,1.0252941176470591]
["CIGNA - CIGNA STANDARD - HCPCS - J2001","CIGNA - CIGNA STANDARD - J2001 - PR LIDOCAINE INJECTION","CIGNA","CIGNA STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,3.4850980392156847,0.03,456.36,1.0252941176470591]
["AETNA - AETNA POS - HCPCS - J2001","AETNA - AETNA POS - J2001 - PR LIDOCAINE INJECTION","AETNA","AETNA POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.1713725490196083,0.03,456.36,1.0252941176470591]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J2001","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["AETNA - AETNA PPO EPO - HCPCS - J2001","AETNA - AETNA PPO EPO - J2001 - PR LIDOCAINE INJECTION","AETNA","AETNA PPO EPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.171372549019607,0.03,456.36,1.0252941176470587]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2001","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J2001 - PR LIDOCAINE INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,4.1013725490196062,0.03,456.36,1.0252941176470589]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2001","AETNA - AETNA STUDENT HEALTH - J2001 - PR LIDOCAINE INJECTION","AETNA","AETNA STUDENT HEALTH","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.1713725490196079,0.03,456.36,1.0252941176470587]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J2001 - PR LIDOCAINE INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.9639215686274518,0.03,456.36,1.0252941176470589]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2001","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J2001 - PR LIDOCAINE INJECTION","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470589]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2001","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J2001 - PR LIDOCAINE INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.9639215686274527,0.03,456.36,1.0252941176470594]
["BCBS - BCBS HMO - HCPCS - J2001","BCBS - BCBS HMO - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CCA - CCA SCO STANDARD - HCPCS - J2001","CCA - CCA SCO STANDARD - J2001 - PR LIDOCAINE INJECTION","CCA","CCA SCO STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["BCBS - BCBS INDEMNITY - HCPCS - J2001","BCBS - BCBS INDEMNITY - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS INDEMNITY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.9639215686274527,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J2001","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J2001 - PR LIDOCAINE INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS POS - HCPCS - J2001","BCBS - BCBS POS - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS POS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2001","CCA MEDICARE PREFERRED - ZZZCCA - J2001 - PR LIDOCAINE INJECTION","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS PPO - HCPCS - J2001","BCBS - BCBS PPO - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,2.9639215686274518,0.03,456.36,1.0252941176470589]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2001","CIGNA - CIGNA LOCALPLUS - J2001 - PR LIDOCAINE INJECTION","CIGNA","CIGNA LOCALPLUS","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,3.4850980392156838,0.03,456.36,1.0252941176470585]
["BCBS - BCBS SHIP PPO - HCPCS - J2001","BCBS - BCBS SHIP PPO - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS SHIP PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196062,2.9639215686274532,0.03,456.36,1.0252941176470589]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2001","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470589]
["BCBS - BCBS STANDARD - HCPCS - J2001","BCBS - BCBS STANDARD - J2001 - PR LIDOCAINE INJECTION","BCBS","BCBS STANDARD","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.9639215686274527,0.03,456.36,1.0252941176470587]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2001","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J2001 - PR LIDOCAINE INJECTION","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,4.101372549019608,0.03,456.36,1.0252941176470591]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2001","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J2001 - PR LIDOCAINE INJECTION","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.101372549019608,2.9639215686274527,0.03,456.36,1.0252941176470589]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J2001","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - J2001 - PR LIDOCAINE INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",4.1013725490196071,4.1013725490196071,0.03,456.36,1.0252941176470587]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J3490","ZZZCIGNA - ZZZCIGNA STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,386.34808510638294,0.41,7676.82,113.63319148936164]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3490","ZZZAETNA - ZZZAETNA POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZAETNA","ZZZAETNA POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,240.44595744680842,0.41,7676.82,113.63319148936164]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J3490","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J3490","ZZZCCA ONECARE - ZZZCCA ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J3490","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936161]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J3490","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936164]
["UNITED - UNITED DEFINITY HRA - HCPCS - J3490","UNITED - UNITED DEFINITY HRA - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED","UNITED DEFINITY HRA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936166]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3490","ZZZAETNA - ZZZAETNA HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZAETNA","ZZZAETNA HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,240.44595744680848,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J3490","WORKERS COMP - WORKERS COMP CCMSI - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,194.26404255319147,0.41,7676.82,113.63319148936165]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J3490","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,240.44595744680842,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936164]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J3490","ZZZCIGNA - CIGNA LOCALPLUS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,386.348085106383,0.41,7676.82,113.63319148936169]
["UNITED - UNITED NAVIGATE - HCPCS - J3490","UNITED - UNITED NAVIGATE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED","UNITED NAVIGATE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3490","ZZZUNITED - ZZZUNITED STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J3490","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936171]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J3490","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J3490","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J3490","WORKERS COMP - WORKERS COMP COVE RISK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,194.26404255319156,0.41,7676.82,113.63319148936169]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J3490","ZZZAETNA - ZZZAETNA MCR SUPP - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,240.44595744680842,0.41,7676.82,113.63319148936159]
["UNITED - UNITED STANDARD - HCPCS - J3490","UNITED - UNITED STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED","UNITED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J3490","ZZZAETNA - ZZZAETNA PPO-EPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,240.44595744680845,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J3490","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,194.26404255319147,0.41,7676.82,113.63319148936159]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J3490","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,194.26404255319153,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J3490","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J3490","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,194.26404255319147,0.41,7676.82,113.63319148936171]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J3490","ZZZCIGNA - ZZZCIGNA CARELINK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,301.41787234042562,0.41,7676.82,113.63319148936169]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J3490","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J3490","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936169]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J3490","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J3490","ZZZUNITED - ZZZUNITED DEFINITY HRA - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936166]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J3490","TUFTS MEDICARE - TUFTS MEDICARE HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936169]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J3490","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936171]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J3490","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J3490","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J3490","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J3490","WORKERS COMP - WORKERS COMP MBTA - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,194.26404255319153,0.41,7676.82,113.63319148936171]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J3490","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,181.81170212765952,0.41,7676.82,113.63319148936161]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936165]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J3490","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,194.26404255319153,0.41,7676.82,113.63319148936161]
["WELLCARE - WELLCARE HMO - HCPCS - J3490","WELLCARE - WELLCARE HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLCARE","WELLCARE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936164]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J3490","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J3490","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J3490","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,194.26404255319156,0.41,7676.82,113.63319148936165]
["WELLCARE - WELLCARE PPO - HCPCS - J3490","WELLCARE - WELLCARE PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J3490","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936165]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,420.34000000000009,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J3490","WORKERS COMP - WORKERS COMP STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,194.26404255319156,0.41,7676.82,113.63319148936164]
["WELLCARE - WELLCARE STANDARD - HCPCS - J3490","WELLCARE - WELLCARE STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042569,454.52787234042569,0.41,7676.82,113.63319148936169]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J3490","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J3490","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J3490","WORKERS COMP - WORKERS COMP THE HARTFORD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J3490","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,163.63042553191491,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,420.34000000000009,0.41,7676.82,113.63319148936159]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,420.34000000000009,0.41,7676.82,113.63319148936164]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3490","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936166]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J3490","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3490","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936159]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,420.34000000000009,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J3490","WORKERS COMP - ZZZWORKERS COMP AIG - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,194.26404255319153,0.41,7676.82,113.63319148936169]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J3490","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J3490","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J3490","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,194.26404255319153,0.41,7676.82,113.63319148936169]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J3490","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,194.26404255319147,0.41,7676.82,113.63319148936165]
["UNICARE - UNICARE STANDARD - HCPCS - J3490","UNICARE - UNICARE STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNICARE","UNICARE STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,340.89723404255318,0.41,7676.82,113.63319148936164]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J3490","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936165]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J3490","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,194.26404255319147,0.41,7676.82,113.63319148936171]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J3490","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J3490 - PR DRUGS UNCLASSIFIED INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,194.26404255319147,0.41,7676.82,113.63319148936169]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3490","FALLON - FALLON COMMUNITY PLAN - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON","FALLON COMMUNITY PLAN","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,227.26680851063824,0.41,7676.82,113.63319148936164]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J3490","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936159]
["FALLON - FALLON PPO STANDARD - HCPCS - J3490","FALLON - FALLON PPO STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON","FALLON PPO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,227.26680851063824,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936172]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3490","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,420.34000000000009,0.41,7676.82,113.63319148936164]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J3490","CORRECTIONS - CORRECTIONS ICE INMATE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3490","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936172]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3490","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["FALLON - FALLON HMO STANDARD - HCPCS - J3490","FALLON - FALLON HMO STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON","FALLON HMO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,227.26680851063824,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J3490","CORRECTIONS - CORRECTIONS MIDDLESEX - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936166]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J3490","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J3490","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS CEDAR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["FALLON SCO - FALLON SCO HMO - HCPCS - J3490","FALLON SCO - FALLON SCO HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON SCO","FALLON SCO HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J3490","CORRECTIONS - CORRECTIONS NAPHCARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS CONCORD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J3490","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J3490","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936165]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J3490","CORRECTIONS - CORRECTIONS PLYMOUTH - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936165]
["HSN - HSN STANDARD - HCPCS - J3490","HSN - HSN STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN","HSN STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936171]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J3490","CORRECTIONS - CORRECTIONS NASHUA - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936165]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936175]
["FALLON - FALLON POS STANDARD - HCPCS - J3490","FALLON - FALLON POS STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","FALLON","FALLON POS STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,227.26680851063821,0.41,7676.82,113.63319148936169]
["HSN - HSN TEMPORARY - HCPCS - J3490","HSN - HSN TEMPORARY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN","HSN TEMPORARY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936171]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,255.99127659574469,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J3490","HSN BAD DEBT - HSN BAD DEBT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042569,456.3600000000003,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936165]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J3490","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J3490","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,456.3600000000003,0.41,7676.82,113.63319148936166]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J3490","OXFORD HEALTH - OXFORD HEALTH STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936164]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J3490","CORRECTIONS - CORRECTIONS NORFOLK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936165]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J3490","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["HSN DENTAL - HSN DENTAL - HCPCS - J3490","HSN DENTAL - HSN DENTAL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN DENTAL","HSN DENTAL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,456.3600000000003,0.41,7676.82,113.63319148936166]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J3490","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J3490","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,454.52787234042523,0.41,7676.82,113.63319148936171]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J3490","HSN PARTIAL - HSN PARTIAL STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,456.3600000000003,0.41,7676.82,113.63319148936171]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J3490","TRICARE EAST - TRICARE EAST PRIME (HMO) - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936169]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J3490","TRICARE EAST - TRICARE EAST SELECT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J3490","HSN PARTIAL - HSN PARTIAL TEMPORARY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,456.3600000000003,0.41,7676.82,113.63319148936165]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J3490","TRICARE FOR LIFE - TRICARE FOR LIFE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS NASHUA - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS CARELINK - HCPCS - J3490","TUFTS - TUFTS CARELINK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS","TUFTS CARELINK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,298.5776595744681,0.41,7676.82,113.63319148936165]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J3490","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS HMO - HCPCS - J3490","TUFTS - TUFTS HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS","TUFTS HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,298.29744680851064,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J3490","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS POS - HCPCS - J3490","TUFTS - TUFTS POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS","TUFTS POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,298.29744680851076,0.41,7676.82,113.63319148936165]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,255.99127659574481,0.41,7676.82,113.63319148936171]
["TUFTS - TUFTS PPO - HCPCS - J3490","TUFTS - TUFTS PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS","TUFTS PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,298.57765957446804,0.41,7676.82,113.63319148936171]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TUFTS - TUFTS SELECT - HCPCS - J3490","TUFTS - TUFTS SELECT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS","TUFTS SELECT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,283.46468085106397,0.41,7676.82,113.63319148936164]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,255.99127659574458,0.41,7676.82,113.63319148936161]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS GARDNER - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936166]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J3490","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,255.99127659574461,0.41,7676.82,113.63319148936156]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3490","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3490","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,420.34000000000009,0.41,7676.82,113.63319148936171]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J3490","AETNA - AETNA STUDENT HEALTH - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA STUDENT HEALTH","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,240.44595744680845,0.41,7676.82,113.63319148936169]
["AETNA - AETNA PPO EPO - HCPCS - J3490","AETNA - AETNA PPO EPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA PPO EPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,240.44595744680842,0.41,7676.82,113.63319148936166]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J3490","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936172]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J3490","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936164]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3490","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936164]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3490","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["AETNA - AETNA HMO - HCPCS - J3490","AETNA - AETNA HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,240.44595744680853,0.41,7676.82,113.63319148936171]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936171]
["BCBS - BCBS SHIP PPO - HCPCS - J3490","BCBS - BCBS SHIP PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS SHIP PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,349.57723404255319,0.41,7676.82,113.63319148936169]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3490","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,349.5772340425533,0.41,7676.82,113.63319148936164]
["BCBS - BCBS STANDARD - HCPCS - J3490","BCBS - BCBS STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,349.57723404255313,0.41,7676.82,113.63319148936166]
["BCBS - BCBS HMO - HCPCS - J3490","BCBS - BCBS HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,349.57723404255319,0.41,7676.82,113.63319148936165]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J3490","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,349.5772340425533,0.41,7676.82,113.63319148936169]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J3490","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,349.57723404255319,0.41,7676.82,113.63319148936165]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J3490","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["AETNA - AETNA MCR SUPP - HCPCS - J3490","AETNA - AETNA MCR SUPP - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA MCR SUPP","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,240.44595744680845,0.41,7676.82,113.63319148936165]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J3490","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J3490","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,349.5772340425533,0.41,7676.82,113.63319148936165]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J3490","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,454.52787234042563,0.41,7676.82,113.63319148936169]
["BCBS - BCBS INDEMNITY - HCPCS - J3490","BCBS - BCBS INDEMNITY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS INDEMNITY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,349.57723404255313,0.41,7676.82,113.63319148936169]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J3490","CCA MEDICARE PREFERRED - ZZZCCA - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936165]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J3490","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,349.57723404255319,0.41,7676.82,113.63319148936172]
["CIGNA - CIGNA CARELINK - HCPCS - J3490","CIGNA - CIGNA CARELINK - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CIGNA","CIGNA CARELINK","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,301.41787234042562,0.41,7676.82,113.63319148936166]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J3490","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936161]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J3490","CIGNA - CIGNA LOCALPLUS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CIGNA","CIGNA LOCALPLUS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,386.34808510638294,0.41,7676.82,113.63319148936166]
["CCA - CCA SCO ONECARE - HCPCS - J3490","CCA - CCA SCO ONECARE - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CCA","CCA SCO ONECARE","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["CIGNA - CIGNA STANDARD - HCPCS - J3490","CIGNA - CIGNA STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CIGNA","CIGNA STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042563,386.34808510638277,0.41,7676.82,113.63319148936164]
["BCBS - BCBS POS - HCPCS - J3490","BCBS - BCBS POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042523,349.5772340425533,0.41,7676.82,113.63319148936164]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J3490","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042535,454.52787234042535,0.41,7676.82,113.63319148936161]
["CCA - CCA SCO STANDARD - HCPCS - J3490","CCA - CCA SCO STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CCA","CCA SCO STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,454.52787234042557,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J3490","CORRECTIONS - CORRECTIONS BRISTOL - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["AETNA - AETNA POS - HCPCS - J3490","AETNA - AETNA POS - J3490 - PR DRUGS UNCLASSIFIED INJECTION","AETNA","AETNA POS","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042557,240.44595744680848,0.41,7676.82,113.63319148936169]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J3490","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936171]
["CCA - ZZZCCA STANDARD - HCPCS - J3490","CCA - ZZZCCA STANDARD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CCA","ZZZCCA STANDARD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.5278723404254,454.5278723404254,0.41,7676.82,113.63319148936166]
["BCBS - BCBS PPO - HCPCS - J3490","BCBS - BCBS PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS","BCBS PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,349.57723404255319,0.41,7676.82,113.63319148936165]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J3490","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936166]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J3490","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J3490 - PR DRUGS UNCLASSIFIED INJECTION","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",454.52787234042546,454.52787234042546,0.41,7676.82,113.63319148936169]
["TUFTS - TUFTS SPIRIT - HCPCS - J3490","TUFTS - TUFTS SPIRIT - J3490 - PR DRUGS UNCLASSIFIED INJECTION","TUFTS","TUFTS SPIRIT","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",447.6991304347826,447.6991304347826,0.41,7676.82,111.92608695652173]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2704","ZZZAETNA - ZZZAETNA MCR SUPP - J2704 - PR INJ, PROPFOL, 10 MG","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,9.175333333333338,0.88,456.36,4.3362222222222249]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J2704","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,7.4124444444444473,0.88,456.36,4.3362222222222249]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J2704","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J2704 - PR INJ, PROPFOL, 10 MG","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,420.34000000000009,0.88,456.36,4.336222222222224]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J2704","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,7.4124444444444473,0.88,456.36,4.336222222222224]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222249]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2704","ZZZCIGNA - CIGNA LOCALPLUS - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111134,14.740444444444456,0.88,456.36,4.3362222222222258]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,420.34000000000009,0.88,456.36,4.3362222222222231]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J2704","ZZZUNITED - ZZZUNITED STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2704","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,7.4124444444444455,0.88,456.36,4.3362222222222249]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,420.34000000000009,0.88,456.36,4.3362222222222249]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2704","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,7.4124444444444446,0.88,456.36,4.3362222222222231]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J2704","TUFTS MEDICARE - TUFTS MEDICARE HMO - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2704","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J2704 - PR INJ, PROPFOL, 10 MG","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,9.175333333333338,0.88,456.36,4.3362222222222231]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2704","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2704","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J2704","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J2704","ZZZUNITED - ZZZUNITED DEFINITY HRA - J2704 - PR INJ, PROPFOL, 10 MG","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J2704","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2704","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,7.4124444444444455,0.88,456.36,4.3362222222222231]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2704","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222284]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J2704","WORKERS COMP - WORKERS COMP MBTA - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,7.4124444444444482,0.88,456.36,4.3362222222222249]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2704","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2704","WORKERS COMP - WORKERS COMP THE HARTFORD - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,7.4124444444444428,0.88,456.36,4.336222222222224]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2704","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,7.4124444444444455,0.88,456.36,4.3362222222222249]
["UBH HPHC - UBH HPHC - HCPCS - J2704","UBH HPHC - UBH HPHC - J2704 - PR INJ, PROPFOL, 10 MG","UBH HPHC","UBH HPHC","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J2704","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J2704 - PR INJ, PROPFOL, 10 MG","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,7.4124444444444446,0.88,456.36,4.3362222222222231]
["UBH HPHC - UBH HPHC - HCPCS - J3490","UBH HPHC - UBH HPHC - J3490 - PR DRUGS UNCLASSIFIED INJECTION","UBH HPHC","UBH HPHC","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",471.94533333333328,471.94533333333328,0.41,7676.82,117.98755555555545]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2704","ZZZAETNA - ZZZAETNA PPO-EPO - J2704 - PR INJ, PROPFOL, 10 MG","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,9.175333333333338,0.88,456.36,4.336222222222224]
["UNICARE - UNICARE STANDARD - HCPCS - J2704","UNICARE - UNICARE STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","UNICARE","UNICARE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,4.7377777777777759,0.88,456.36,4.3362222222222231]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2704","ZZZCCA ONECARE - ZZZCCA ONECARE - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["UNITED - UNITED DEFINITY HRA - HCPCS - J2704","UNITED - UNITED DEFINITY HRA - J2704 - PR INJ, PROPFOL, 10 MG","UNITED","UNITED DEFINITY HRA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2704","ZZZCIGNA - ZZZCIGNA STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,14.740444444444446,0.88,456.36,4.336222222222224]
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["TUFTS - TUFTS CARELINK - HCPCS - J2704","TUFTS - TUFTS CARELINK - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS CARELINK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS NASHUA - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2704","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J2704","CORRECTIONS - CORRECTIONS MIDDLESEX - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J2704","CORRECTIONS - CORRECTIONS PLYMOUTH - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS CONCORD - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2704","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["MEDICARE - MEDICARE A&B - HCPCS - J2704","MEDICARE - MEDICARE A&B - J2704 - PR INJ, PROPFOL, 10 MG","MEDICARE","MEDICARE A&B","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J3490","MEDICARE - RAILROAD MEDICARE  RAILROAD - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",471.94533333333351,471.94533333333351,0.41,7676.82,117.98755555555557]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222222]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["TUFTS - TUFTS PPO - HCPCS - J2704","TUFTS - TUFTS PPO - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2704","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J2704","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J2704 - PR INJ, PROPFOL, 10 MG","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,456.36000000000024,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2704","HSN PARTIAL - HSN PARTIAL TEMPORARY - J2704 - PR INJ, PROPFOL, 10 MG","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,456.36000000000024,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J2704","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J2704 - PR INJ, PROPFOL, 10 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,9.7657777777777817,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2704","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222275]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2704","MEDICARE - MEDICARE PART A ONLY - J2704 - PR INJ, PROPFOL, 10 MG","MEDICARE","MEDICARE PART A ONLY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS GARDNER - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J2704","CORRECTIONS - CORRECTIONS NAPHCARE - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222222]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2704","OXFORD HEALTH - OXFORD HEALTH STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2704","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2704","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2704","FALLON - FALLON COMMUNITY PLAN - J2704 - PR INJ, PROPFOL, 10 MG","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,8.6742222222222285,0.88,456.36,4.3362222222222249]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J2704","TRICARE FOR LIFE - TRICARE FOR LIFE - J2704 - PR INJ, PROPFOL, 10 MG","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["FALLON - FALLON HMO STANDARD - HCPCS - J2704","FALLON - FALLON HMO STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","FALLON","FALLON HMO STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,8.6742222222222285,0.88,456.36,4.3362222222222258]
["TUFTS - TUFTS HMO - HCPCS - J2704","TUFTS - TUFTS HMO - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222222]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS SELECT - HCPCS - J2704","TUFTS - TUFTS SELECT - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS SELECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["FALLON - FALLON POS STANDARD - HCPCS - J2704","FALLON - FALLON POS STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","FALLON","FALLON POS STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,8.6742222222222249,0.88,456.36,4.3362222222222231]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - J2704","HSN BAD DEBT - HSN BAD DEBT - J2704 - PR INJ, PROPFOL, 10 MG","HSN BAD DEBT","HSN BAD DEBT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,456.36000000000024,0.88,456.36,4.336222222222224]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,420.34000000000009,0.88,456.36,4.3362222222222258]
["HSN DENTAL - HSN DENTAL - HCPCS - J2704","HSN DENTAL - HSN DENTAL - J2704 - PR INJ, PROPFOL, 10 MG","HSN DENTAL","HSN DENTAL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222258]
["FALLON - FALLON PPO STANDARD - HCPCS - J2704","FALLON - FALLON PPO STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","FALLON","FALLON PPO STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,8.6742222222222285,0.88,456.36,4.336222222222224]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2704","HSN PARTIAL - HSN PARTIAL STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222249]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2704","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J2704 - PR INJ, PROPFOL, 10 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J2704","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2704","CORRECTIONS - CORRECTIONS NORFOLK - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2704","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J2704 - PR INJ, PROPFOL, 10 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2704","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J2704 - PR INJ, PROPFOL, 10 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,9.7657777777777799,0.88,456.36,4.3362222222222231]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J2704","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J2704 - PR INJ, PROPFOL, 10 MG","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2704","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J2704 - PR INJ, PROPFOL, 10 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,9.7657777777777817,0.88,456.36,4.3362222222222231]
["FALLON SCO - FALLON SCO HMO - HCPCS - J2704","FALLON SCO - FALLON SCO HMO - J2704 - PR INJ, PROPFOL, 10 MG","FALLON SCO","FALLON SCO HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2704","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J2704 - PR INJ, PROPFOL, 10 MG","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,9.7657777777777817,0.88,456.36,4.3362222222222249]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["MEDICARE - MEDICARE A&B - HCPCS - J3490","MEDICARE - MEDICARE A&B - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MEDICARE","MEDICARE A&B","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",471.94533333333345,471.94533333333345,0.41,7676.82,117.98755555555557]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J2704 - PR INJ, PROPFOL, 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3490","MEDICARE - MEDICARE PART A ONLY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MEDICARE","MEDICARE PART A ONLY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",471.94533333333345,471.94533333333345,0.41,7676.82,117.98755555555555]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J2704 - PR INJ, PROPFOL, 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J3490","MEDICARE - MEDICARE PART B ONLY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","MEDICARE","MEDICARE PART B ONLY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",471.94533333333317,471.94533333333317,0.41,7676.82,117.98755555555555]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J2704 - PR INJ, PROPFOL, 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J2704","MEDICARE - RAILROAD MEDICARE  RAILROAD - J2704 - PR INJ, PROPFOL, 10 MG","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222222]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J2704 - PR INJ, PROPFOL, 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222266]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2704","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J2704 - PR INJ, PROPFOL, 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2704","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2704","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J2704 - PR INJ, PROPFOL, 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222258]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2704","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J2704","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J2704 - PR INJ, PROPFOL, 10 MG","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J2704","TRICARE EAST - TRICARE EAST PRIME (HMO) - J2704 - PR INJ, PROPFOL, 10 MG","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2704","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J2704 - PR INJ, PROPFOL, 10 MG","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J2704","TRICARE EAST - TRICARE EAST SELECT - J2704 - PR INJ, PROPFOL, 10 MG","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222266]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J2704","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J2704 - PR INJ, PROPFOL, 10 MG","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111116,17.345111111111116,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2704","CORRECTIONS - CORRECTIONS ICE INMATE - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.336222222222224]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J2704","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222266]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2704","CORRECTIONS - CORRECTIONS NASHUA - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS POS - HCPCS - J2704","TUFTS - TUFTS POS - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J2704","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J2704 - PR INJ, PROPFOL, 10 MG","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["HSN - HSN STANDARD - HCPCS - J2704","HSN - HSN STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","HSN","HSN STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,456.36000000000024,0.88,456.36,4.3362222222222249]
["TUFTS - TUFTS SPIRIT - HCPCS - J2704","TUFTS - TUFTS SPIRIT - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS","TUFTS SPIRIT","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222222]
["HSN - HSN TEMPORARY - HCPCS - J2704","HSN - HSN TEMPORARY - J2704 - PR INJ, PROPFOL, 10 MG","HSN","HSN TEMPORARY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,456.36000000000024,0.88,456.36,4.3362222222222249]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2704","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J2704 - PR INJ, PROPFOL, 10 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,420.34000000000009,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2704","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222231]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J2704","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222258]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J2704","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J2704 - PR INJ, PROPFOL, 10 MG","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CCA - CCA SCO STANDARD - HCPCS - J2704","CCA - CCA SCO STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","CCA","CCA SCO STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["BCBS - BCBS POS - HCPCS - J2704","BCBS - BCBS POS - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BCBS POS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["CIGNA - CIGNA CARELINK - HCPCS - J2704","CIGNA - CIGNA CARELINK - J2704 - PR INJ, PROPFOL, 10 MG","CIGNA","CIGNA CARELINK","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111137,17.345111111111137,0.88,456.36,4.3362222222222275]
["BCBS - BCBS PPO - HCPCS - J2704","BCBS - BCBS PPO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BCBS PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222231]
["BCBS - BCBS INDEMNITY - HCPCS - J2704","BCBS - BCBS INDEMNITY - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BCBS INDEMNITY","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.336222222222224]
["AETNA - AETNA HMO - HCPCS - J2704","AETNA - AETNA HMO - J2704 - PR INJ, PROPFOL, 10 MG","AETNA","AETNA HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,9.175333333333338,0.88,456.36,4.336222222222224]
["CCA - ZZZCCA STANDARD - HCPCS - J2704","CCA - ZZZCCA STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","CCA","ZZZCCA STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS - BCBS SHIP PPO - HCPCS - J2704","BCBS - BCBS SHIP PPO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BCBS SHIP PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.3362222222222249]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2704","CCA MEDICARE PREFERRED - ZZZCCA - J2704 - PR INJ, PROPFOL, 10 MG","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS - BCBS STANDARD - HCPCS - J2704","BCBS - BCBS STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BCBS STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111137,17.345111111111137,0.88,456.36,4.3362222222222275]
["CIGNA - CIGNA STANDARD - HCPCS - J2704","CIGNA - CIGNA STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","CIGNA","CIGNA STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,14.740444444444458,0.88,456.36,4.3362222222222258]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J2704","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J2704 - PR INJ, PROPFOL, 10 MG","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2704","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J2704 - PR INJ, PROPFOL, 10 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J2704","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J2704 - PR INJ, PROPFOL, 10 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,17.34511111111112,0.88,456.36,4.3362222222222231]
["AETNA - AETNA MCR SUPP - HCPCS - J2704","AETNA - AETNA MCR SUPP - J2704 - PR INJ, PROPFOL, 10 MG","AETNA","AETNA MCR SUPP","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,9.1753333333333398,0.88,456.36,4.3362222222222258]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2704","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J2704 - PR INJ, PROPFOL, 10 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J2704","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111123,17.345111111111123,0.88,456.36,4.336222222222224]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2704","AETNA - AETNA STUDENT HEALTH - J2704 - PR INJ, PROPFOL, 10 MG","AETNA","AETNA STUDENT HEALTH","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,9.1753333333333345,0.88,456.36,4.3362222222222213]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J2704","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J2704 - PR INJ, PROPFOL, 10 MG","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J2704","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J2704 - PR INJ, PROPFOL, 10 MG","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J2704","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111113,17.34511111111113,0.88,456.36,4.3362222222222258]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2704","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J2704 - PR INJ, PROPFOL, 10 MG","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222249]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2704","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J2704 - PR INJ, PROPFOL, 10 MG","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111134,17.345111111111134,0.88,456.36,4.3362222222222275]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J2704","CIGNA - CIGNA LOCALPLUS - J2704 - PR INJ, PROPFOL, 10 MG","CIGNA","CIGNA LOCALPLUS","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.34511111111112,14.740444444444446,0.88,456.36,4.3362222222222231]
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["CCA - CCA SCO ONECARE - HCPCS - J2704","CCA - CCA SCO ONECARE - J2704 - PR INJ, PROPFOL, 10 MG","CCA","CCA SCO ONECARE","HCPCS","J2704","PR INJ, PROPFOL, 10 MG","J2704 - PR INJ, PROPFOL, 10 MG",17.345111111111127,17.345111111111127,0.88,456.36,4.3362222222222258]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1815","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1815 - PR INSULIN INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J1815","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J1815 - PR INSULIN INJECTION","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,41.60625000000001,1.62,456.36,10.403750000000002]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1580","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999997]
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["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J0690","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806454]
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["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0690","WORKERS COMP - ZZZWORKERS COMP AIG - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999975,0.17,456.36,3.0412903225806462]
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["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J0690","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,5.1999999999999975,0.17,456.36,3.0412903225806462]
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["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J0690","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999993,0.17,456.36,3.0412903225806462]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J0690","ZZZUNITED - ZZZUNITED STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J0690","UNITED - UNITED PASSPORT CONNECT - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED","UNITED PASSPORT CONNECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
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["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J0690","WORKERS COMP - WORKERS COMP CCMSI - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999975,0.17,456.36,3.0412903225806454]
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["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J0690","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.2,0.17,456.36,3.0412903225806462]
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["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J0690","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999993,0.17,456.36,3.0412903225806458]
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["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J0690","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999966,0.17,456.36,3.0412903225806454]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J0690","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
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["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J0690","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999984,0.17,456.36,3.0412903225806462]
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["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J0690","ZZZAETNA - ZZZAETNA MCR SUPP - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,6.4364516129032259,0.17,456.36,3.0412903225806458]
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["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J0690","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,5.2,0.17,456.36,3.0412903225806454]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J0690","ZZZAETNA - ZZZAETNA POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZAETNA","ZZZAETNA POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,6.4364516129032268,0.17,456.36,3.0412903225806458]
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["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J0690","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999993,0.17,456.36,3.0412903225806458]
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["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J0690","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.2,0.17,456.36,3.0412903225806454]
["UNICARE - UNICARE STANDARD - HCPCS - J0690","UNICARE - UNICARE STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNICARE","UNICARE STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,4.8132258064516131,0.17,456.36,3.0412903225806467]
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["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J0690","WORKERS COMP - WORKERS COMP THE HARTFORD - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999984,0.17,456.36,3.0412903225806454]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J0690","ZZZCCA ONECARE - ZZZCCA ONECARE - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806458]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J0690","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,5.1999999999999975,0.17,456.36,3.0412903225806454]
["WELLCARE - WELLCARE PPO - HCPCS - J0690","WELLCARE - WELLCARE PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J0690","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J0690 - PR CEFAZOLIN SODIUM INJECTION","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,5.1999999999999966,0.17,456.36,3.0412903225806458]
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["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J0690","ZZZCIGNA - CIGNA LOCALPLUS - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,10.338387096774193,0.17,456.36,3.0412903225806454]
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["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J0690","CORRECTIONS - CORRECTIONS MIDDLESEX - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806454]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806458]
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["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806454]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
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["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J0690","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806454]
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["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J0690 - PR CEFAZOLIN SODIUM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806462]
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["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J0690","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["TUFTS - TUFTS SELECT - HCPCS - J0690","TUFTS - TUFTS SELECT - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS","TUFTS SELECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,11.159354838709678,0.17,456.36,3.0412903225806462]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,420.34000000000009,0.17,456.36,3.0412903225806462]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J0690","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,6.8509677419354844,0.17,456.36,3.0412903225806454]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS NASHUA - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J0690","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J0690","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J0690","CORRECTIONS - CORRECTIONS NAPHCARE - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["FALLON - FALLON HMO STANDARD - HCPCS - J0690","FALLON - FALLON HMO STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON","FALLON HMO STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,6.0861290322580635,0.17,456.36,3.0412903225806458]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS GARDNER - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806458]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J0690","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,12.164516129032261,0.17,456.36,3.0412903225806458]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J0690 - PR CEFAZOLIN SODIUM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J0690","TRICARE EAST - TRICARE EAST PRIME (HMO) - J0690 - PR CEFAZOLIN SODIUM INJECTION","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J0690","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J0690","HSN PARTIAL - HSN PARTIAL STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,456.36000000000018,0.17,456.36,3.0412903225806454]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J0690","TRICARE FOR LIFE - TRICARE FOR LIFE - J0690 - PR CEFAZOLIN SODIUM INJECTION","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J0690","CORRECTIONS - CORRECTIONS ICE INMATE - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["TUFTS - TUFTS CARELINK - HCPCS - J0690","TUFTS - TUFTS CARELINK - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS","TUFTS CARELINK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,11.252258064516129,0.17,456.36,3.0412903225806462]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806449]
["FALLON - FALLON POS STANDARD - HCPCS - J0690","FALLON - FALLON POS STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON","FALLON POS STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,6.0861290322580635,0.17,456.36,3.0412903225806462]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J0690","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["TUFTS - TUFTS HMO - HCPCS - J0690","TUFTS - TUFTS HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS","TUFTS HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,11.252258064516129,0.17,456.36,3.0412903225806462]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J0690","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J0690 - PR CEFAZOLIN SODIUM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J0690","CORRECTIONS - CORRECTIONS NASHUA - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,12.164516129032261,0.17,456.36,3.0412903225806462]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["TUFTS - TUFTS POS - HCPCS - J0690","TUFTS - TUFTS POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS","TUFTS POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,11.252258064516129,0.17,456.36,3.0412903225806462]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0690","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["TUFTS - TUFTS PPO - HCPCS - J0690","TUFTS - TUFTS PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS","TUFTS PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,11.252258064516127,0.17,456.36,3.0412903225806454]
["FALLON - FALLON PPO STANDARD - HCPCS - J0690","FALLON - FALLON PPO STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON","FALLON PPO STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,6.0861290322580635,0.17,456.36,3.0412903225806458]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806467]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806454]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS CEDAR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["TUFTS - TUFTS SPIRIT - HCPCS - J0690","TUFTS - TUFTS SPIRIT - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS","TUFTS SPIRIT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0690","FALLON - FALLON COMMUNITY PLAN - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON","FALLON COMMUNITY PLAN","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,6.0861290322580635,0.17,456.36,3.0412903225806458]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J0690","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J0690 - PR CEFAZOLIN SODIUM INJECTION","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,456.36000000000018,0.17,456.36,3.0412903225806454]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806462]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J0690","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J0690","OXFORD HEALTH - OXFORD HEALTH STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["HSN DENTAL - HSN DENTAL - HCPCS - J0690","HSN DENTAL - HSN DENTAL - J0690 - PR CEFAZOLIN SODIUM INJECTION","HSN DENTAL","HSN DENTAL","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,456.36000000000018,0.17,456.36,3.0412903225806462]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J0690","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J0690 - PR CEFAZOLIN SODIUM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J0690","CORRECTIONS - CORRECTIONS NORFOLK - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["AETNA - AETNA POS - HCPCS - J0690","AETNA - AETNA POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,6.4364516129032259,0.17,456.36,3.0412903225806458]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J0690","AETNA - AETNA STUDENT HEALTH - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA STUDENT HEALTH","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,6.4364516129032259,0.17,456.36,3.0412903225806462]
["BCBS - BCBS INDEMNITY - HCPCS - J0690","BCBS - BCBS INDEMNITY - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS INDEMNITY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806454]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J0690","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["BCBS - BCBS PPO - HCPCS - J0690","BCBS - BCBS PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,12.164516129032261,0.17,456.36,3.0412903225806462]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J0690","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806462]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J0690","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["BCBS - BCBS STANDARD - HCPCS - J0690","BCBS - BCBS STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J0690","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,12.164516129032261,0.17,456.36,3.0412903225806462]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J0690","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806462]
["CCA - ZZZCCA STANDARD - HCPCS - J0690","CCA - ZZZCCA STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA","ZZZCCA STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806454]
["AETNA - AETNA PPO EPO - HCPCS - J0690","AETNA - AETNA PPO EPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA PPO EPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,6.4364516129032259,0.17,456.36,3.0412903225806454]
["AETNA - AETNA HMO - HCPCS - J0690","AETNA - AETNA HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,6.4364516129032259,0.17,456.36,3.0412903225806467]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J0690","CCA MEDICARE PREFERRED - ZZZCCA - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806454]
["CCA - CCA SCO ONECARE - HCPCS - J0690","CCA - CCA SCO ONECARE - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA","CCA SCO ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J0690","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J0690","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["AETNA - AETNA MCR SUPP - HCPCS - J0690","AETNA - AETNA MCR SUPP - J0690 - PR CEFAZOLIN SODIUM INJECTION","AETNA","AETNA MCR SUPP","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,6.4364516129032268,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J0690","CORRECTIONS - CORRECTIONS BRISTOL - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,12.164516129032261,0.17,456.36,3.0412903225806458]
["CIGNA - CIGNA CARELINK - HCPCS - J0690","CIGNA - CIGNA CARELINK - J0690 - PR CEFAZOLIN SODIUM INJECTION","CIGNA","CIGNA CARELINK","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,11.252258064516127,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J0690","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806467]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J0690","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,12.164516129032261,0.17,456.36,3.0412903225806467]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J0690","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["BCBS - BCBS HMO - HCPCS - J0690","BCBS - BCBS HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806458]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J0690","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J0690 - PR CEFAZOLIN SODIUM INJECTION","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806462]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J0690","CIGNA - CIGNA LOCALPLUS - J0690 - PR CEFAZOLIN SODIUM INJECTION","CIGNA","CIGNA LOCALPLUS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,10.338387096774191,0.17,456.36,3.0412903225806462]
["BCBS - BCBS POS - HCPCS - J0690","BCBS - BCBS POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,12.164516129032259,0.17,456.36,3.0412903225806458]
["BCBS - BCBS SHIP PPO - HCPCS - J0690","BCBS - BCBS SHIP PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","BCBS","BCBS SHIP PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032261,12.164516129032261,0.17,456.36,3.0412903225806462]
["CIGNA - CIGNA STANDARD - HCPCS - J0690","CIGNA - CIGNA STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","CIGNA","CIGNA STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032259,10.338387096774195,0.17,456.36,3.0412903225806458]
["CCA - CCA SCO STANDARD - HCPCS - J0690","CCA - CCA SCO STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","CCA","CCA SCO STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.164516129032258,12.164516129032258,0.17,456.36,3.0412903225806458]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.174482758620689,12.174482758620689,0.17,456.36,3.0437931034482766]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.174482758620689,12.174482758620689,0.17,456.36,3.0437931034482766]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.174482758620687,12.174482758620687,0.17,456.36,3.0437931034482761]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.174482758620687,12.174482758620687,0.17,456.36,3.0437931034482761]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J0690","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.174482758620691,12.174482758620691,0.17,456.36,3.0437931034482766]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J1170","ZZZAETNA - ZZZAETNA POS - J1170 - PR HYDROMORPHONE INJECTION","ZZZAETNA","ZZZAETNA POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,37.589259259259265,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J1953","WORKERS COMP - WORKERS COMP STANDARD - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,26.574444444444438,3.5,456.36,15.545555555555552]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J1953","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J1953 - PR LEVETIRACETAM INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J1953","UNITED - UNITED PASSPORT CONNECT - J1953 - PR LEVETIRACETAM INJECTION","UNITED","UNITED PASSPORT CONNECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666669,62.176666666666669,3.5,456.36,15.545555555555554]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J1953","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["UNITED - UNITED HP SHIP - HCPCS - J1953","UNITED - UNITED HP SHIP - J1953 - PR LEVETIRACETAM INJECTION","UNITED","UNITED HP SHIP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J1953","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J1953 - PR LEVETIRACETAM INJECTION","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["UNITED - UNITED STANDARD - HCPCS - J1170","UNITED - UNITED STANDARD - J1170 - PR HYDROMORPHONE INJECTION","UNITED","UNITED STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1170","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,30.369259259259259,0.23,511.56,17.765555555555554]
["UNITED - UNITED STANDARD - HCPCS - J1953","UNITED - UNITED STANDARD - J1953 - PR LEVETIRACETAM INJECTION","UNITED","UNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1170","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J1170 - PR HYDROMORPHONE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J0690","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148161]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J1170","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J1170 - PR HYDROMORPHONE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J1170","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J1170 - PR HYDROMORPHONE INJECTION","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1953","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J1953 - PR LEVETIRACETAM INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,32.891111111111115,3.5,456.36,15.545555555555552]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J1953","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J1953 - PR LEVETIRACETAM INJECTION","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J1170","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J1170 - PR HYDROMORPHONE INJECTION","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1170","ZZZUNITED - ZZZUNITED STANDARD - J1170 - PR HYDROMORPHONE INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J0690","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J1953","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444435,3.5,456.36,15.545555555555554]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J1170","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J1170 - PR HYDROMORPHONE INJECTION","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J1953","WORKERS COMP - WORKERS COMP THE HARTFORD - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,26.574444444444449,3.5,456.36,15.545555555555552]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J1953","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J1953 - PR LEVETIRACETAM INJECTION","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1953","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J1953 - PR LEVETIRACETAM INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J0690","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148161]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1953","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J1170","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J1170 - PR HYDROMORPHONE INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J1953","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J1953 - PR LEVETIRACETAM INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555556]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1170","ZZZAETNA - ZZZAETNA PPO-EPO - J1170 - PR HYDROMORPHONE INJECTION","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,37.589259259259258,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J1953","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J1953 - PR LEVETIRACETAM INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J0690","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148148]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1953","ZZZCIGNA - ZZZCIGNA CARELINK - J1953 - PR LEVETIRACETAM INJECTION","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J1170","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J1170 - PR HYDROMORPHONE INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J0690","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",11.837407407407406,11.837407407407406,0.17,456.36,2.9596296296296298]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J1953","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J1953 - PR LEVETIRACETAM INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["UNITED - UNITED NAVIGATE - HCPCS - J1953","UNITED - UNITED NAVIGATE - J1953 - PR LEVETIRACETAM INJECTION","UNITED","UNITED NAVIGATE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,420.34000000000009,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J1170","WORKERS COMP - WORKERS COMP MBTA - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J0690","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,420.34000000000009,0.23,511.56,17.765555555555558]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J1170","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J1170 - PR HYDROMORPHONE INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J1953","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J1953 - PR LEVETIRACETAM INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666641,62.176666666666641,3.5,456.36,15.545555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,420.34000000000009,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,420.34000000000009,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1170","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555554]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J0690","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J1953","WORKERS COMP - ZZZWORKERS COMP AIG - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666669,26.574444444444449,3.5,456.36,15.545555555555554]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J1170","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J1170 - PR HYDROMORPHONE INJECTION","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1953","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J1953","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J1953 - PR LEVETIRACETAM INJECTION","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1953","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444449,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,420.34000000000009,3.5,456.36,15.545555555555554]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J1170","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555554]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J0690","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J1170","ZZZAETNA - ZZZAETNA HMO - J1170 - PR HYDROMORPHONE INJECTION","ZZZAETNA","ZZZAETNA HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,37.589259259259265,0.23,511.56,17.765555555555554]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J1170","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J1170 - PR HYDROMORPHONE INJECTION","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J1170","ZZZAETNA - ZZZAETNA MCR SUPP - J1170 - PR HYDROMORPHONE INJECTION","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,37.589259259259265,0.23,511.56,17.765555555555554]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J1953","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J1953 - PR LEVETIRACETAM INJECTION","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,420.34000000000009,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J0690","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1170","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J1170 - PR HYDROMORPHONE INJECTION","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,28.422222222222217,0.23,511.56,17.765555555555554]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J1170","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J1170 - PR HYDROMORPHONE INJECTION","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1953","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J1953 - PR LEVETIRACETAM INJECTION","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,24.86888888888889,3.5,456.36,15.545555555555552]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J1953","ZZZCCA ONECARE - ZZZCCA ONECARE - J1953 - PR LEVETIRACETAM INJECTION","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,420.34000000000009,0.23,511.56,17.765555555555558]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J1953","ZZZCIGNA - CIGNA LOCALPLUS - J1953 - PR LEVETIRACETAM INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,52.847777777777772,3.5,456.36,15.545555555555554]
["WELLCARE - WELLCARE HMO - HCPCS - J1170","WELLCARE - WELLCARE HMO - J1170 - PR HYDROMORPHONE INJECTION","WELLCARE","WELLCARE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1170","ZZZCIGNA - ZZZCIGNA STANDARD - J1170 - PR HYDROMORPHONE INJECTION","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,60.399259259259253,0.23,511.56,17.765555555555558]
["WELLCARE - WELLCARE HMO - HCPCS - J1953","WELLCARE - WELLCARE HMO - J1953 - PR LEVETIRACETAM INJECTION","WELLCARE","WELLCARE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["UBH HPHC - UBH HPHC - HCPCS - J1953","UBH HPHC - UBH HPHC - J1953 - PR LEVETIRACETAM INJECTION","UBH HPHC","UBH HPHC","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["WELLCARE - WELLCARE PPO - HCPCS - J1170","WELLCARE - WELLCARE PPO - J1170 - PR HYDROMORPHONE INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1953","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J1953 - PR LEVETIRACETAM INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.54555555555555]
["WELLCARE - WELLCARE PPO - HCPCS - J1953","WELLCARE - WELLCARE PPO - J1953 - PR LEVETIRACETAM INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.54555555555555]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J1953","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666669,420.34000000000009,3.5,456.36,15.545555555555552]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J1953","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1170","WELLCARE - WELLCARE STANDARD - J1170 - PR HYDROMORPHONE INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555562]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,420.34000000000009,3.5,456.36,15.545555555555554]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1953","WELLCARE - WELLCARE STANDARD - J1953 - PR LEVETIRACETAM INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J1953","WORKERS COMP - WORKERS COMP MBTA - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1953","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J1170","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J1170 - PR HYDROMORPHONE INJECTION","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,25.580370370370375,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J1170","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,30.369259259259259,0.23,511.56,17.765555555555554]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J1953","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J1953 - PR LEVETIRACETAM INJECTION","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,22.383333333333333,3.5,456.36,15.545555555555556]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1953","UNITED - UNITED DEFINITY HRA - J1953 - PR LEVETIRACETAM INJECTION","UNITED","UNITED DEFINITY HRA","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J0690","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J1170","WORKERS COMP - WORKERS COMP STANDARD - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,30.369259259259255,0.23,511.56,17.765555555555558]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J1170","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J1170 - PR HYDROMORPHONE INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J1953","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J1953 - PR LEVETIRACETAM INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J1170","WORKERS COMP - WORKERS COMP THE HARTFORD - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J0690","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J0690 - PR CEFAZOLIN SODIUM INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148148]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J0690","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148148]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J1170","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J1170 - PR HYDROMORPHONE INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1953","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555554]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J1953","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J1953 - PR LEVETIRACETAM INJECTION","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.54555555555555]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J1170","WORKERS COMP - ZZZWORKERS COMP AIG - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,30.369259259259252,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J0690","TUFTS MEDICARE - TUFTS MEDICARE HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148148]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,420.34000000000009,3.5,456.36,15.545555555555552]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1953","UNITED - UNITED HP STUDENT HEALTH - J1953 - PR LEVETIRACETAM INJECTION","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1170","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1170","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555551]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J1170","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J1953","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555552]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1170","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1170","TUFTS MEDICARE - TUFTS MEDICARE HMO - J1170 - PR HYDROMORPHONE INJECTION","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1170","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J0690","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1170","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J1953","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444453,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J1953","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666669,26.574444444444438,3.5,456.36,15.545555555555554]
["UNITED - UNITED NAVIGATE - HCPCS - J1170","UNITED - UNITED NAVIGATE - J1170 - PR HYDROMORPHONE INJECTION","UNITED","UNITED NAVIGATE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1953","TUFTS MEDICARE - TUFTS MEDICARE HMO - J1953 - PR LEVETIRACETAM INJECTION","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J1953","ZZZAETNA - ZZZAETNA HMO - J1953 - PR LEVETIRACETAM INJECTION","ZZZAETNA","ZZZAETNA HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,32.891111111111115,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1170","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,30.369259259259248,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J1953","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J1953 - PR LEVETIRACETAM INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1953","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666669,26.574444444444445,3.5,456.36,15.545555555555556]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J1953","ZZZAETNA - ZZZAETNA MCR SUPP - J1953 - PR LEVETIRACETAM INJECTION","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,32.891111111111115,3.5,456.36,15.54555555555555]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J1953","ZZZAETNA - ZZZAETNA POS - J1953 - PR LEVETIRACETAM INJECTION","ZZZAETNA","ZZZAETNA POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666641,32.891111111111115,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1170","WORKERS COMP - WORKERS COMP CCMSI - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555551]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1953","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J1953 - PR LEVETIRACETAM INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1953","WORKERS COMP - WORKERS COMP CCMSI - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666669,26.574444444444445,3.5,456.36,15.545555555555556]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1953","ZZZAETNA - ZZZAETNA PPO-EPO - J1953 - PR LEVETIRACETAM INJECTION","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,32.891111111111115,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1170","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259259,0.23,511.56,17.765555555555554]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1170","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J1170 - PR HYDROMORPHONE INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,37.589259259259265,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1953","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444438,3.5,456.36,15.545555555555554]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J1170","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J1170 - PR HYDROMORPHONE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J0690","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J1953","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555556]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J1170","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555554]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J1170","ZZZCCA ONECARE - ZZZCCA ONECARE - J1170 - PR HYDROMORPHONE INJECTION","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J1953","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,26.574444444444445,3.5,456.36,15.545555555555554]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J1170","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J1170 - PR HYDROMORPHONE INJECTION","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1170","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J1170 - PR HYDROMORPHONE INJECTION","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J1170","ZZZCIGNA - CIGNA LOCALPLUS - J1170 - PR HYDROMORPHONE INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,60.39925925925926,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J1170","WORKERS COMP - WORKERS COMP COVE RISK - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,30.369259259259266,0.23,511.56,17.765555555555562]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1170","ZZZCIGNA - ZZZCIGNA CARELINK - J1170 - PR HYDROMORPHONE INJECTION","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,64.286666666666676,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J1953","WORKERS COMP - WORKERS COMP COVE RISK - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444445,3.5,456.36,15.545555555555552]
["UBH HPHC - UBH HPHC - HCPCS - J0690","UBH HPHC - UBH HPHC - J0690 - PR CEFAZOLIN SODIUM INJECTION","UBH HPHC","UBH HPHC","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",11.837407407407408,11.837407407407408,0.17,456.36,2.9596296296296294]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1953","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J1953 - PR LEVETIRACETAM INJECTION","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1953","ZZZCIGNA - ZZZCIGNA STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,52.847777777777772,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1170","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555554]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J1953","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J1953 - PR LEVETIRACETAM INJECTION","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,26.574444444444449,3.5,456.36,15.545555555555554]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J1953","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,26.574444444444438,3.5,456.36,15.545555555555552]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,420.34000000000009,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1170","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,30.369259259259255,0.23,511.56,17.765555555555558]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1953","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J1953 - PR LEVETIRACETAM INJECTION","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555556]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1953","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,26.574444444444435,3.5,456.36,15.545555555555556]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J1953","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J1953 - PR LEVETIRACETAM INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J1953","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - J1953 - PR LEVETIRACETAM INJECTION","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["UNICARE - UNICARE STANDARD - HCPCS - J1170","UNICARE - UNICARE STANDARD - J1170 - PR HYDROMORPHONE INJECTION","UNICARE","UNICARE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,36.827777777777769,0.23,511.56,17.765555555555558]
["UNICARE - UNICARE STANDARD - HCPCS - J1953","UNICARE - UNICARE STANDARD - J1953 - PR LEVETIRACETAM INJECTION","UNICARE","UNICARE STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,5.833333333333333,3.5,456.36,15.545555555555554]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J0690","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - J0690 - PR CEFAZOLIN SODIUM INJECTION","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",11.837407407407408,11.837407407407408,0.17,456.36,2.9596296296296307]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J1953","ZZZUNITED - ZZZUNITED DEFINITY HRA - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J1953","ZZZUNITED - ZZZUNITED HP SHIP - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED HP SHIP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - J1170","ZZZUNITED - ZZZUNITED DEFINITY HRA - J1170 - PR HYDROMORPHONE INJECTION","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1170","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259255,0.23,511.56,17.765555555555554]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,420.34000000000009,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J1953","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666641,26.574444444444438,3.5,456.36,15.545555555555552]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J1953","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1170","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J1170 - PR HYDROMORPHONE INJECTION","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,30.369259259259252,0.23,511.56,17.765555555555554]
["UNITED - UNITED DEFINITY HRA - HCPCS - J1170","UNITED - UNITED DEFINITY HRA - J1170 - PR HYDROMORPHONE INJECTION","UNITED","UNITED DEFINITY HRA","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1953","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J1953 - PR LEVETIRACETAM INJECTION","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,26.574444444444435,3.5,456.36,15.545555555555554]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1953","ZZZUNITED - ZZZUNITED STANDARD - J1953 - PR LEVETIRACETAM INJECTION","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J0690","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J0690 - PR CEFAZOLIN SODIUM INJECTION","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J1170","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J1170 - PR HYDROMORPHONE INJECTION","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J1953","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J1953 - PR LEVETIRACETAM INJECTION","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["HSN - HSN STANDARD - HCPCS - J1170","HSN - HSN STANDARD - J1170 - PR HYDROMORPHONE INJECTION","HSN","HSN STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555558]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1953","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J1953","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J1953 - PR LEVETIRACETAM INJECTION","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,456.36000000000013,3.5,456.36,15.545555555555552]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J1953","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J1953 - PR LEVETIRACETAM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS CEDAR - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["TUFTS - TUFTS SELECT - HCPCS - J1170","TUFTS - TUFTS SELECT - J1170 - PR HYDROMORPHONE INJECTION","TUFTS","TUFTS SELECT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,63.595555555555563,0.23,511.56,17.765555555555558]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J1953","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J1953 - PR LEVETIRACETAM INJECTION","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS CEDAR - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0690","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS - TUFTS CARELINK - HCPCS - J1170","TUFTS - TUFTS CARELINK - J1170 - PR HYDROMORPHONE INJECTION","TUFTS","TUFTS CARELINK","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,64.286666666666662,0.23,511.56,17.765555555555554]
["HSN DENTAL - HSN DENTAL - HCPCS - J1170","HSN DENTAL - HSN DENTAL - J1170 - PR HYDROMORPHONE INJECTION","HSN DENTAL","HSN DENTAL","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,456.36000000000013,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["HSN DENTAL - HSN DENTAL - HCPCS - J1953","HSN DENTAL - HSN DENTAL - J1953 - PR LEVETIRACETAM INJECTION","HSN DENTAL","HSN DENTAL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,456.36000000000013,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J1170","CORRECTIONS - CORRECTIONS NORFOLK - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555562]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1953","CORRECTIONS - CORRECTIONS MIDDLESEX - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1170","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J1170 - PR HYDROMORPHONE INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J1953","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J1953 - PR LEVETIRACETAM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1953","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J1953 - PR LEVETIRACETAM INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1953","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J1953 - PR LEVETIRACETAM INJECTION","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555556]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J1170","CORRECTIONS - CORRECTIONS NASHUA - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["FALLON - FALLON HMO STANDARD - HCPCS - J1170","FALLON - FALLON HMO STANDARD - J1170 - PR HYDROMORPHONE INJECTION","FALLON","FALLON HMO STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,35.53037037037037,0.23,511.56,17.765555555555554]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1170","HSN PARTIAL - HSN PARTIAL STANDARD - J1170 - PR HYDROMORPHONE INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J1953","HSN PARTIAL - HSN PARTIAL STANDARD - J1953 - PR LEVETIRACETAM INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,456.36000000000013,3.5,456.36,15.545555555555552]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J1953","CORRECTIONS - CORRECTIONS NORFOLK - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["TUFTS - TUFTS POS - HCPCS - J1170","TUFTS - TUFTS POS - J1170 - PR HYDROMORPHONE INJECTION","TUFTS","TUFTS POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,64.286666666666662,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J1170","CORRECTIONS - CORRECTIONS PLYMOUTH - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0690","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1170","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J1170 - PR HYDROMORPHONE INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,420.34000000000009,0.23,511.56,17.765555555555558]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1170","HSN PARTIAL - HSN PARTIAL TEMPORARY - J1170 - PR HYDROMORPHONE INJECTION","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1953","HSN PARTIAL - HSN PARTIAL TEMPORARY - J1953 - PR LEVETIRACETAM INJECTION","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,456.36000000000013,3.5,456.36,15.545555555555554]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J1953","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555556]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS CONCORD - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1170","FALLON - FALLON COMMUNITY PLAN - J1170 - PR HYDROMORPHONE INJECTION","FALLON","FALLON COMMUNITY PLAN","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,35.53037037037037,0.23,511.56,17.765555555555554]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1170","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J1170 - PR HYDROMORPHONE INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J1953","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J1953 - PR LEVETIRACETAM INJECTION","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS CONCORD - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1953","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J1953 - PR LEVETIRACETAM INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J0690","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518519,12.938518518518519,1.17,456.36,3.2348148148148153]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J1170","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J1170 - PR HYDROMORPHONE INJECTION","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J1953","CORRECTIONS - CORRECTIONS ICE INMATE - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666641,62.176666666666641,3.5,456.36,15.545555555555552]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J1953","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J1953 - PR LEVETIRACETAM INJECTION","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555552]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1953","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J1953 - PR LEVETIRACETAM INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555556]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555558]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J0690","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J1170","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J1170 - PR HYDROMORPHONE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,40.018148148148157,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J1170","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J1170 - PR HYDROMORPHONE INJECTION","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J1953","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J1953 - PR LEVETIRACETAM INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["FALLON SCO - FALLON SCO HMO - HCPCS - J0690","FALLON SCO - FALLON SCO HMO - J0690 - PR CEFAZOLIN SODIUM INJECTION","FALLON SCO","FALLON SCO HMO","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J1170","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J1170 - PR HYDROMORPHONE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,40.018148148148157,0.23,511.56,17.765555555555554]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J1170","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J1170 - PR HYDROMORPHONE INJECTION","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["TUFTS - TUFTS CARELINK - HCPCS - J1953","TUFTS - TUFTS CARELINK - J1953 - PR LEVETIRACETAM INJECTION","TUFTS","TUFTS CARELINK","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J1953","CORRECTIONS - ZZZCORRECTIONS NASHUA - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555554]
["TUFTS - TUFTS POS - HCPCS - J1953","TUFTS - TUFTS POS - J1953 - PR LEVETIRACETAM INJECTION","TUFTS","TUFTS POS","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["HSN - HSN TEMPORARY - HCPCS - J1170","HSN - HSN TEMPORARY - J1170 - PR HYDROMORPHONE INJECTION","HSN","HSN TEMPORARY","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,456.36000000000013,0.23,511.56,17.765555555555554]
["TUFTS - TUFTS SELECT - HCPCS - J1953","TUFTS - TUFTS SELECT - J1953 - PR LEVETIRACETAM INJECTION","TUFTS","TUFTS SELECT","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J1170","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J1170 - PR HYDROMORPHONE INJECTION","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925948,71.055925925925948,0.23,511.56,17.765555555555558]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J1170","OXFORD HEALTH - OXFORD HEALTH STANDARD - J1170 - PR HYDROMORPHONE INJECTION","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,71.055925925925933,0.23,511.56,17.765555555555554]
["AETNA - AETNA MCR SUPP - HCPCS - J1953","AETNA - AETNA MCR SUPP - J1953 - PR LEVETIRACETAM INJECTION","AETNA","AETNA MCR SUPP","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,32.891111111111108,3.5,456.36,15.545555555555552]
["CCA - CCA SCO ONECARE - HCPCS - J1953","CCA - CCA SCO ONECARE - J1953 - PR LEVETIRACETAM INJECTION","CCA","CCA SCO ONECARE","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666669,62.176666666666669,3.5,456.36,15.545555555555554]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J1953","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666648,62.176666666666648,3.5,456.36,15.545555555555552]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1953","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J1953 - PR LEVETIRACETAM INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J1170","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J1170 - PR HYDROMORPHONE INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925933,66.654444444444451,0.23,511.56,17.765555555555554]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J1170","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J1170 - PR HYDROMORPHONE INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J1953","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J1953 - PR LEVETIRACETAM INJECTION","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["BCBS - BCBS HMO - HCPCS - J1170","BCBS - BCBS HMO - J1170 - PR HYDROMORPHONE INJECTION","BCBS","BCBS HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,66.654444444444437,0.23,511.56,17.765555555555554]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J1170","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J1170 - PR HYDROMORPHONE INJECTION","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555554]
["BCBS - BCBS STANDARD - HCPCS - J1953","BCBS - BCBS STANDARD - J1953 - PR LEVETIRACETAM INJECTION","BCBS","BCBS STANDARD","HCPCS","J1953","PR LEVETIRACETAM INJECTION","J1953 - PR LEVETIRACETAM INJECTION",62.176666666666655,62.176666666666655,3.5,456.36,15.545555555555554]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0690","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J0690 - PR CEFAZOLIN SODIUM INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J0690","PR CEFAZOLIN SODIUM INJECTION","J0690 - PR CEFAZOLIN SODIUM INJECTION",12.938518518518517,12.938518518518517,1.17,456.36,3.2348148148148153]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1170","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J1170 - PR HYDROMORPHONE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925919,71.055925925925919,0.23,511.56,17.765555555555551]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1170","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J1170 - PR HYDROMORPHONE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",71.055925925925905,71.055925925925905,0.23,511.56,17.765555555555554]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J1170","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J1170 - PR HYDROMORPHONE INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",60.876538461538459,60.876538461538459,0.23,511.56,15.220769230769228]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J1170","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J1170 - PR HYDROMORPHONE INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",60.876538461538459,60.876538461538459,0.23,511.56,15.220769230769228]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - J1170","MEDICARE - RAILROAD MEDICARE  RAILROAD - J1170 - PR HYDROMORPHONE INJECTION","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",72.546538461538475,72.546538461538475,0.23,511.56,18.138076923076927]
["MEDICARE - MEDICARE A&B - HCPCS - J1170","MEDICARE - MEDICARE A&B - J1170 - PR HYDROMORPHONE INJECTION","MEDICARE","MEDICARE A&B","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",72.546538461538461,72.546538461538461,0.23,511.56,18.138076923076923]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J1170","TRICARE EAST - TRICARE EAST SELECT - J1170 - PR HYDROMORPHONE INJECTION","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J1170","PR HYDROMORPHONE INJECTION","J1170 - PR HYDROMORPHONE INJECTION",72.546538461538475,72.546538461538475,0.23,511.56,18.138076923076923]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J3490","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",370.19727272727272,185.10045454545454,1.01,7444.48,92.551363636363646]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J3490","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",370.19727272727272,185.10045454545454,1.01,7444.48,92.551363636363646]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J3490","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J3490 - PR DRUGS UNCLASSIFIED INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J3490","PR DRUGS UNCLASSIFIED INJECTION","J3490 - PR DRUGS UNCLASSIFIED INJECTION",370.19727272727272,185.10045454545454,1.01,7444.48,92.551363636363646]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J2001","UNITED - UNITED PASSPORT CONNECT - J2001 - PR LIDOCAINE INJECTION","UNITED","UNITED PASSPORT CONNECT","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.3747368421052628,2.3747368421052628,0.03,456.36,0.59315789473684211]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J2001","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J2001 - PR LIDOCAINE INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.3747368421052637,2.3747368421052637,0.03,456.36,0.593157894736842]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J2001","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J2001 - PR LIDOCAINE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J2001","PR LIDOCAINE INJECTION","J2001 - PR LIDOCAINE INJECTION",2.3747368421052637,2.3747368421052637,0.03,456.36,0.59315789473684188]
["WELLCARE - WELLCARE PPO - HCPCS - J1815","WELLCARE - WELLCARE PPO - J1815 - PR INSULIN INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606249999999996,41.606249999999996,1.62,456.36,10.403749999999999]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J1580","WORKERS COMP - WORKERS COMP STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.20812500000001,17.186250000000001,0.79,456.36,10.052500000000002]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J1580","UNITED - UNITED HP STUDENT HEALTH - J1580 - PR GARAMYCIN GENTAMICIN INJ","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1580","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1580","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.20812500000001,40.20812500000001,0.79,456.36,10.052500000000002]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J1580","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J1580 - PR GARAMYCIN GENTAMICIN INJ","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J1815","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J1815 - PR INSULIN INJECTION","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,17.781875000000003,1.62,456.36,10.40375]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J1815","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J1815 - PR INSULIN INJECTION","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,17.781874999999999,1.62,456.36,10.40375]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1815","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J1815 - PR INSULIN INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,420.34000000000009,1.62,456.36,10.403749999999999]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J1815","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J1815 - PR INSULIN INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,41.60625000000001,1.62,456.36,10.403750000000002]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J1580","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J1580 - PR GARAMYCIN GENTAMICIN INJ","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,17.186249999999998,0.79,456.36,10.0525]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1580","WELLCARE - WELLCARE STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","WELLCARE","WELLCARE STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J1815","WORKERS COMP - WORKERS COMP MBTA - J1815 - PR INSULIN INJECTION","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606249999999996,17.781874999999996,1.62,456.36,10.40375]
["WELLCARE - WELLCARE HMO - HCPCS - J1580","WELLCARE - WELLCARE HMO - J1580 - PR GARAMYCIN GENTAMICIN INJ","WELLCARE","WELLCARE HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999988,40.208124999999988,0.79,456.36,10.052499999999998]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J1580","ZZZAETNA - ZZZAETNA POS - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZAETNA","ZZZAETNA POS","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,21.270624999999999,0.79,456.36,10.052500000000002]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1580","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J1580 - PR GARAMYCIN GENTAMICIN INJ","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,17.186250000000001,0.79,456.36,10.0525]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1815","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J1815 - PR INSULIN INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,420.34000000000009,1.62,456.36,10.403749999999999]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J1580","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J1580 - PR GARAMYCIN GENTAMICIN INJ","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1815","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J1815 - PR INSULIN INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,22.010625000000001,1.62,456.36,10.40375]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J1580","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1580","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,420.34000000000009,0.79,456.36,10.0525]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1815","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J1815 - PR INSULIN INJECTION","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,16.641249999999999,1.62,456.36,10.403749999999999]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J1580","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J1580 - PR GARAMYCIN GENTAMICIN INJ","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1580","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.052500000000002]
["WELLCARE - WELLCARE STANDARD - HCPCS - J1815","WELLCARE - WELLCARE STANDARD - J1815 - PR INSULIN INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1815","FALLON - FALLON COMMUNITY PLAN - J1815 - PR INSULIN INJECTION","FALLON","FALLON COMMUNITY PLAN","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,20.806249999999999,1.62,456.36,10.403749999999999]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J1580","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J1815","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J1815 - PR INSULIN INJECTION","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,41.606250000000003,1.62,456.36,10.40375]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1580","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J1580 - PR GARAMYCIN GENTAMICIN INJ","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J1580","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999998]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J1580","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J1580 - PR GARAMYCIN GENTAMICIN INJ","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["HSN DENTAL - HSN DENTAL - HCPCS - J1580","HSN DENTAL - HSN DENTAL - J1580 - PR GARAMYCIN GENTAMICIN INJ","HSN DENTAL","HSN DENTAL","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,456.3599999999999,0.79,456.36,10.0525]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1580","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999998]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J1815","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J1815 - PR INSULIN INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1580","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999988,40.208124999999988,0.79,456.36,10.052499999999998]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J1815","TRICARE EAST - TRICARE EAST SELECT - J1815 - PR INSULIN INJECTION","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606249999999996,41.606249999999996,1.62,456.36,10.40375]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J1815","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J1815 - PR INSULIN INJECTION","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1580","CORRECTIONS - CORRECTIONS MIDDLESEX - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J1815","HSN PARTIAL - HSN PARTIAL TEMPORARY - J1815 - PR INSULIN INJECTION","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,456.3599999999999,1.62,456.36,10.40375]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J1815","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J1815 - PR INSULIN INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,23.432500000000005,1.62,456.36,10.403750000000002]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J1580","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.052499999999998]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J1815","CORRECTIONS - CORRECTIONS MIDDLESEX - J1815 - PR INSULIN INJECTION","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606249999999996,41.606249999999996,1.62,456.36,10.40375]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J1580","MEDICARE - MEDICARE PART B ONLY - J1580 - PR GARAMYCIN GENTAMICIN INJ","MEDICARE","MEDICARE PART B ONLY","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1580","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J1580 - PR GARAMYCIN GENTAMICIN INJ","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J1580","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,420.34000000000009,0.79,456.36,10.052499999999998]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J1815","TRICARE EAST - TRICARE EAST PRIME (HMO) - J1815 - PR INSULIN INJECTION","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J1580","TRICARE FOR LIFE - TRICARE FOR LIFE - J1580 - PR GARAMYCIN GENTAMICIN INJ","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.20812500000001,40.20812500000001,0.79,456.36,10.052500000000002]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1580","FALLON - FALLON COMMUNITY PLAN - J1580 - PR GARAMYCIN GENTAMICIN INJ","FALLON","FALLON COMMUNITY PLAN","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,20.107499999999998,0.79,456.36,10.0525]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J1580","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J1580 - PR GARAMYCIN GENTAMICIN INJ","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000004]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1580","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J1580 - PR GARAMYCIN GENTAMICIN INJ","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,420.34000000000009,0.79,456.36,10.0525]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J1815","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J1815 - PR INSULIN INJECTION","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J1815","CORRECTIONS - CORRECTIONS BRISTOL - J1815 - PR INSULIN INJECTION","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J1580","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["BCBS - BCBS STANDARD - HCPCS - J1580","BCBS - BCBS STANDARD - J1580 - PR GARAMYCIN GENTAMICIN INJ","BCBS","BCBS STANDARD","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.0525]
["BCBS - BCBS PPO - HCPCS - J1580","BCBS - BCBS PPO - J1580 - PR GARAMYCIN GENTAMICIN INJ","BCBS","BCBS PPO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208124999999995,40.208124999999995,0.79,456.36,10.0525]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J1580","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J1580 - PR GARAMYCIN GENTAMICIN INJ","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,40.208125000000003,0.79,456.36,10.052500000000002]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J1815","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J1815 - PR INSULIN INJECTION","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["AETNA - AETNA HMO - HCPCS - J1580","AETNA - AETNA HMO - J1580 - PR GARAMYCIN GENTAMICIN INJ","AETNA","AETNA HMO","HCPCS","J1580","PR GARAMYCIN GENTAMICIN INJ","J1580 - PR GARAMYCIN GENTAMICIN INJ",40.208125000000003,21.270625000000003,0.79,456.36,10.052500000000002]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J1815","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J1815 - PR INSULIN INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,38.462500000000006,1.62,456.36,10.403749999999999]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1815","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J1815 - PR INSULIN INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.60625000000001,41.60625000000001,1.62,456.36,10.40375]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J1815","CCA MEDICARE PREFERRED - ZZZCCA - J1815 - PR INSULIN INJECTION","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,41.606250000000003,1.62,456.36,10.40375]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J1815","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J1815 - PR INSULIN INJECTION","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",41.606250000000003,41.606250000000003,1.62,456.36,10.403749999999999]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2919","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,420.34000000000009,1.33,456.36,12.073076923076924]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2919","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923088,20.639230769230764,1.33,456.36,12.073076923076924]
["UNICARE - UNICARE STANDARD - HCPCS - J2919","UNICARE - UNICARE STANDARD - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","UNICARE","UNICARE STANDARD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923067,36.214615384615385,1.33,456.36,12.073076923076922]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2919","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,25.542307692307695,1.33,456.36,12.073076923076922]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2919","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,420.34000000000009,1.33,456.36,12.073076923076922]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2919","ZZZAETNA - ZZZAETNA PPO-EPO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,25.542307692307688,1.33,456.36,12.07307692307692]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J2919","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,20.639230769230764,1.33,456.36,12.073076923076924]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2919","WORKERS COMP - WORKERS COMP COVE RISK - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,20.639230769230771,1.33,456.36,12.073076923076924]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2919","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,20.639230769230771,1.33,456.36,12.07307692307692]
["FALLON - FALLON POS STANDARD - HCPCS - J2919","FALLON - FALLON POS STANDARD - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","FALLON","FALLON POS STANDARD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923067,24.14692307692307,1.33,456.36,12.07307692307692]
["HSN DENTAL - HSN DENTAL - HCPCS - J2919","HSN DENTAL - HSN DENTAL - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","HSN DENTAL","HSN DENTAL","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923088,456.35999999999996,1.33,456.36,12.073076923076924]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2919","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923067,27.193076923076926,1.33,456.36,12.073076923076922]
["TUFTS - TUFTS HMO - HCPCS - J2919","TUFTS - TUFTS HMO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","TUFTS","TUFTS HMO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,21.996923076923075,1.33,456.36,12.07307692307692]
["CIGNA - CIGNA STANDARD - HCPCS - J2919","CIGNA - CIGNA STANDARD - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","CIGNA","CIGNA STANDARD","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923088,41.043846153846161,1.33,456.36,12.073076923076922]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2919","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923095,48.286923076923095,1.33,456.36,12.073076923076924]
["AETNA - AETNA HMO - HCPCS - J2919","AETNA - AETNA HMO - J2919 - PR INJ, METHYLPRED SOD SUCC 5MG","AETNA","AETNA HMO","HCPCS","J2919","PR INJ, METHYLPRED SOD SUCC 5MG","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG",48.286923076923081,25.542307692307688,1.33,456.36,12.07307692307692]
["UNICARE - UNICARE STANDARD - HCPCS - J0736","UNICARE - UNICARE STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","UNICARE","UNICARE STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,7.919999999999999,1.9,456.36,7.6799999999999988]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J0736","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,7.6149999999999993,1.9,456.36,7.68]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J1815","ZZZUNITED - ZZZUNITED HP SHIP - J1815 - PR INSULIN INJECTION","ZZZUNITED","ZZZUNITED HP SHIP","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",43.631666666666661,43.631666666666661,1.62,456.36,10.909999999999998]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J0736","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,13.125,1.9,456.36,7.68]
["WELLCARE - WELLCARE STANDARD - HCPCS - J0736","WELLCARE - WELLCARE STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WELLCARE","WELLCARE STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,7.9199999999999982,1.9,456.36,7.6799999999999988]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J0736","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,13.125,1.9,456.36,7.6799999999999988]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - J0736","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,13.125,1.9,456.36,7.68]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J0736","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,7.6149999999999993,1.9,456.36,7.68]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J0736","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,7.6149999999999993,1.9,456.36,7.6799999999999988]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0736","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000006,420.34000000000009,1.9,456.36,7.6799999999999988]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J0736","UNITED - UNITED PASSPORT CONNECT - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","UNITED","UNITED PASSPORT CONNECT","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,30.712500000000002,1.9,456.36,7.68]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J0736","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,7.6150000000000011,1.9,456.36,7.68]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J0736","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,10.545833333333333,1.9,456.36,7.6799999999999988]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J0736","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,7.6150000000000011,1.9,456.36,7.6799999999999988]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J1815","UNITED - UNITED PASSPORT CONNECT - J1815 - PR INSULIN INJECTION","UNITED","UNITED PASSPORT CONNECT","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",43.631666666666661,43.631666666666661,1.62,456.36,10.909999999999998]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J0736","CORRECTIONS - CORRECTIONS MIDDLESEX - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000006,7.9983333333333322,1.9,456.36,7.6800000000000006]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J0736","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,8.3758333333333344,1.9,456.36,7.6799999999999988]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J1815","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J1815 - PR INSULIN INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J1815","PR INSULIN INJECTION","J1815 - PR INSULIN INJECTION",43.631666666666661,43.631666666666661,1.62,456.36,10.910000000000002]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0736","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,7.615000000000002,1.9,456.36,7.68]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J0736","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,7.6150000000000011,1.9,456.36,7.6799999999999988]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0736","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999991,30.712499999999991,1.9,456.36,7.6799999999999988]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J0736","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,420.34000000000009,1.9,456.36,7.6799999999999988]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J0736","CORRECTIONS - CORRECTIONS NAPHCARE - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000006,7.9983333333333322,1.9,456.36,7.68]
["FALLON SCO - FALLON SCO HMO - HCPCS - J0736","FALLON SCO - FALLON SCO HMO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","FALLON SCO","FALLON SCO HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,7.615000000000002,1.9,456.36,7.68]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0736","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,420.34000000000009,1.9,456.36,7.68]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J0736","OXFORD HEALTH - OXFORD HEALTH STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,7.6149999999999993,1.9,456.36,7.68]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J0736","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000006,7.9983333333333322,1.9,456.36,7.68]
["HSN DENTAL - HSN DENTAL - HCPCS - J0736","HSN DENTAL - HSN DENTAL - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","HSN DENTAL","HSN DENTAL","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,456.35999999999996,1.9,456.36,7.6799999999999988]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J0736","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000006,7.9983333333333322,1.9,456.36,7.6799999999999988]
["HSN - HSN STANDARD - HCPCS - J0736","HSN - HSN STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","HSN","HSN STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,456.35999999999996,1.9,456.36,7.68]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0736","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000002,7.6150000000000011,1.9,456.36,7.68]
["AETNA - AETNA POS - HCPCS - J0736","AETNA - AETNA POS - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","AETNA","AETNA POS","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,16.245000000000001,1.9,456.36,7.68]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J0736","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000006,7.615000000000002,1.9,456.36,7.68]
["CCA - ZZZCCA STANDARD - HCPCS - J0736","CCA - ZZZCCA STANDARD - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","CCA","ZZZCCA STANDARD","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712500000000006,7.9983333333333322,1.9,456.36,7.68]
["BCBS - BCBS SHIP PPO - HCPCS - J0736","BCBS - BCBS SHIP PPO - J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","BCBS","BCBS SHIP PPO","HCPCS","J0736","PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",30.712499999999995,9.08,1.9,456.36,7.6799999999999988]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2310","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J2310","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J2310 - PR INJ NALOXONE HYDROCHLORIDE","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2310","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J2310 - PR INJ NALOXONE HYDROCHLORIDE","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2310","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,18.296363636363637,1.73,456.36,10.698181818181821]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J2310","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,18.296363636363637,1.73,456.36,10.698181818181821]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J2310","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,15.406363636363634,1.73,456.36,10.698181818181817]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J2310","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J2310 - PR INJ NALOXONE HYDROCHLORIDE","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,22.638181818181813,1.73,456.36,10.698181818181819]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J2310","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J2310","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J2310 - PR INJ NALOXONE HYDROCHLORIDE","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181817]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J2310","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,18.296363636363637,1.73,456.36,10.698181818181819]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J2310","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J2310 - PR INJ NALOXONE HYDROCHLORIDE","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,18.296363636363637,1.73,456.36,10.698181818181819]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2310","ZZZCIGNA - CIGNA LOCALPLUS - J2310 - PR INJ NALOXONE HYDROCHLORIDE","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,36.380909090909086,1.73,456.36,10.698181818181821]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J2310","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J2310 - PR INJ NALOXONE HYDROCHLORIDE","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J2310","ZZZCIGNA - ZZZCIGNA STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,36.380909090909093,1.73,456.36,10.698181818181819]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2310","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J2310 - PR INJ NALOXONE HYDROCHLORIDE","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2310","FALLON - FALLON COMMUNITY PLAN - J2310 - PR INJ NALOXONE HYDROCHLORIDE","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,21.402727272727272,1.73,456.36,10.698181818181819]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2310","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181817]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J2310","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["TUFTS - TUFTS PPO - HCPCS - J2310","TUFTS - TUFTS PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","TUFTS","TUFTS PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J2310","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["HSN - HSN TEMPORARY - HCPCS - J2310","HSN - HSN TEMPORARY - J2310 - PR INJ NALOXONE HYDROCHLORIDE","HSN","HSN TEMPORARY","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,456.36,1.73,456.36,10.698181818181819]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2310","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J2310","CORRECTIONS - CORRECTIONS NASHUA - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181819]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2310","CORRECTIONS - ZZZCORRECTIONS NASHUA - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2310","OXFORD HEALTH - OXFORD HEALTH STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J2310","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J2310 - PR INJ NALOXONE HYDROCHLORIDE","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J2310","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2310","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181819]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J2310","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J2310","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J2310 - PR INJ NALOXONE HYDROCHLORIDE","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["BCBS - BCBS POS - HCPCS - J2310","BCBS - BCBS POS - J2310 - PR INJ NALOXONE HYDROCHLORIDE","BCBS","BCBS POS","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["BCBS - BCBS PPO - HCPCS - J2310","BCBS - BCBS PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","BCBS","BCBS PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090907,42.799090909090907,1.73,456.36,10.698181818181819]
["BCBS - BCBS SHIP PPO - HCPCS - J2310","BCBS - BCBS SHIP PPO - J2310 - PR INJ NALOXONE HYDROCHLORIDE","BCBS","BCBS SHIP PPO","HCPCS","J2310","PR INJ NALOXONE HYDROCHLORIDE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",42.799090909090914,42.799090909090914,1.73,456.36,10.698181818181821]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J1561","ZZZAETNA - ZZZAETNA HMO - J1561 - PR GAMUNEX-C/GAMMAKED","ZZZAETNA","ZZZAETNA HMO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1915.261,83.55,7890.89,905.13300000000004]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J1561","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J1561 - PR GAMUNEX-C/GAMMAKED","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1547.415,83.55,7890.89,905.13300000000004]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J1561","UNITED - UNITED PASSPORT CONNECT - J1561 - PR GAMUNEX-C/GAMMAKED","UNITED","UNITED PASSPORT CONNECT","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1553.4479999999999,83.55,7890.89,905.13300000000004]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J1561","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J1561 - PR GAMUNEX-C/GAMMAKED","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1547.415,83.55,7890.89,905.13300000000015]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J1561","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J1561 - PR GAMUNEX-C/GAMMAKED","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999993,1547.4150000000002,83.55,7890.89,905.13300000000004]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J1561","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - J1561 - PR GAMUNEX-C/GAMMAKED","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1553.4479999999996,83.55,7890.89,905.13300000000004]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J1561","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J1561 - PR GAMUNEX-C/GAMMAKED","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1547.415,83.55,7890.89,905.13300000000004]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J1561","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J1561 - PR GAMUNEX-C/GAMMAKED","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,420.34000000000003,83.55,7890.89,905.13300000000004]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J9041","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.6600000000008,71.989999999999995,68.569999999999993,4840.46,1423.67]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J1561","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J1561 - PR GAMUNEX-C/GAMMAKED","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,2039.0799999999995,83.55,7890.89,905.13299999999981]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1561","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J1561 - PR GAMUNEX-C/GAMMAKED","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,420.34000000000003,83.55,7890.89,905.13300000000004]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J1561","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J1561 - PR GAMUNEX-C/GAMMAKED","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1553.4480000000001,83.55,7890.89,905.13300000000015]
["TUFTS - TUFTS CARELINK - HCPCS - J1561","TUFTS - TUFTS CARELINK - J1561 - PR GAMUNEX-C/GAMMAKED","TUFTS","TUFTS CARELINK","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1520.9479999999999,83.55,7890.89,905.13300000000004]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J1561","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J1561 - PR GAMUNEX-C/GAMMAKED","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999993,1525.056,83.55,7890.89,905.13300000000015]
["BCBS - BCBS HMO - HCPCS - J1561","BCBS - BCBS HMO - J1561 - PR GAMUNEX-C/GAMMAKED","BCBS","BCBS HMO","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1525.056,83.55,7890.89,905.13300000000015]
["AETNA - AETNA MCR SUPP - HCPCS - J1561","AETNA - AETNA MCR SUPP - J1561 - PR GAMUNEX-C/GAMMAKED","AETNA","AETNA MCR SUPP","HCPCS","J1561","PR GAMUNEX-C/GAMMAKED","J1561 - PR GAMUNEX-C/GAMMAKED",3620.5279999999998,1915.261,83.55,7890.89,905.13299999999981]
["UNICARE - UNICARE STANDARD - HCPCS - J7131","UNICARE - UNICARE STANDARD - J7131 - PR HYPERTONIC SALINE SOL","UNICARE","UNICARE STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,10.338749999999999,0.92,456.36,3.4462499999999996]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J7131","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J7131 - PR HYPERTONIC SALINE SOL","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,5.8937499999999998,0.92,456.36,3.4462499999999996]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J7131","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J7131 - PR HYPERTONIC SALINE SOL","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,5.8937499999999998,0.92,456.36,3.4462499999999996]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J7131","ZZZAETNA - ZZZAETNA POS - J7131 - PR HYPERTONIC SALINE SOL","ZZZAETNA","ZZZAETNA POS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,7.2912499999999998,0.92,456.36,3.44625]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J7131","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J7131 - PR HYPERTONIC SALINE SOL","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,13.785,0.92,456.36,3.44625]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J7131","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J7131 - PR HYPERTONIC SALINE SOL","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J7131","WORKERS COMP - WORKERS COMP MBTA - J7131 - PR HYPERTONIC SALINE SOL","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,5.8937499999999998,0.92,456.36,3.44625]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J7131","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J7131 - PR HYPERTONIC SALINE SOL","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,5.8937500000000007,0.92,456.36,3.44625]
["WELLCARE - WELLCARE STANDARD - HCPCS - J7131","WELLCARE - WELLCARE STANDARD - J7131 - PR HYPERTONIC SALINE SOL","WELLCARE","WELLCARE STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,13.785,0.92,456.36,3.44625]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J7131","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J7131 - PR HYPERTONIC SALINE SOL","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,13.785,0.92,456.36,3.44625]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J7131","ZZZAETNA - ZZZAETNA PPO-EPO - J7131 - PR HYPERTONIC SALINE SOL","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,7.2912499999999998,0.92,456.36,3.44625]
["UNITED - UNITED STANDARD - HCPCS - J7131","UNITED - UNITED STANDARD - J7131 - PR HYPERTONIC SALINE SOL","UNITED","UNITED STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J7131","TRICARE EAST - TRICARE EAST SELECT - J7131 - PR HYPERTONIC SALINE SOL","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - J7131","CORRECTIONS - CORRECTIONS NASHUA - J7131 - PR HYPERTONIC SALINE SOL","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["FALLON SCO - FALLON SCO HMO - HCPCS - J7131","FALLON SCO - FALLON SCO HMO - J7131 - PR HYPERTONIC SALINE SOL","FALLON SCO","FALLON SCO HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,13.785,0.92,456.36,3.44625]
["HSN - HSN STANDARD - HCPCS - J7131","HSN - HSN STANDARD - J7131 - PR HYPERTONIC SALINE SOL","HSN","HSN STANDARD","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,456.36000000000007,0.92,456.36,3.44625]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J7131","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J7131 - PR HYPERTONIC SALINE SOL","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J7131","MEDICARE - MEDICARE PART B ONLY - J7131 - PR HYPERTONIC SALINE SOL","MEDICARE","MEDICARE PART B ONLY","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7131","FALLON - FALLON COMMUNITY PLAN - J7131 - PR HYPERTONIC SALINE SOL","FALLON","FALLON COMMUNITY PLAN","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,6.8924999999999992,0.92,456.36,3.4462499999999996]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J7131","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J7131 - PR HYPERTONIC SALINE SOL","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,13.785,0.92,456.36,3.44625]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J7131","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J7131 - PR HYPERTONIC SALINE SOL","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J7131","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J7131 - PR HYPERTONIC SALINE SOL","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,13.785,0.92,456.36,3.44625]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J7131","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J7131 - PR HYPERTONIC SALINE SOL","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J7131","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J7131 - PR HYPERTONIC SALINE SOL","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,420.34000000000003,0.92,456.36,3.44625]
["BCBS - BCBS PPO - HCPCS - J7131","BCBS - BCBS PPO - J7131 - PR HYPERTONIC SALINE SOL","BCBS","BCBS PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,9.02,0.92,456.36,3.4462499999999996]
["BCBS - BCBS POS - HCPCS - J7131","BCBS - BCBS POS - J7131 - PR HYPERTONIC SALINE SOL","BCBS","BCBS POS","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,9.02,0.92,456.36,3.44625]
["CCA - CCA SCO ONECARE - HCPCS - J7131","CCA - CCA SCO ONECARE - J7131 - PR HYPERTONIC SALINE SOL","CCA","CCA SCO ONECARE","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,13.785,0.92,456.36,3.44625]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J7131","CORRECTIONS - CORRECTIONS BRISTOL - J7131 - PR HYPERTONIC SALINE SOL","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.784999999999998,13.784999999999998,0.92,456.36,3.4462499999999996]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J7131","AETNA - AETNA STUDENT HEALTH - J7131 - PR HYPERTONIC SALINE SOL","AETNA","AETNA STUDENT HEALTH","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",13.785,7.2912499999999998,0.92,456.36,3.44625]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J0137","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J0137","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,18.22,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0137","WORKERS COMP - ZZZWORKERS COMP AIG - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,18.22,5.0999999999999996,456.36,10.659999999999998]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J0137","TUFTS MEDICARE - TUFTS MEDICARE HMO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0137","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,420.34,5.0999999999999996,456.36,10.659999999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0137","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,420.34,5.0999999999999996,456.36,10.659999999999998]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J0137","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0137","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,7.06,5.0999999999999996,456.36,10.659999999999998]
["WELLCARE - WELLCARE HMO - HCPCS - J0137","WELLCARE - WELLCARE HMO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","WELLCARE","WELLCARE HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.3,5.0999999999999996,456.36,10.659999999999998]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J0137","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J0137","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["UNICARE - UNICARE STANDARD - HCPCS - J0137","UNICARE - UNICARE STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","UNICARE","UNICARE STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,6,5.0999999999999996,456.36,10.659999999999998]
["UNITED - UNITED STANDARD - HCPCS - J0137","UNITED - UNITED STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","UNITED","UNITED STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["WELLCARE - WELLCARE PPO - HCPCS - J0137","WELLCARE - WELLCARE PPO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","WELLCARE","WELLCARE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.3,5.0999999999999996,456.36,10.659999999999998]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J0137","TRICARE EAST - TRICARE EAST SELECT - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J0137","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,6.12,5.0999999999999996,456.36,10.659999999999998]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0137","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0137","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J0137","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J0137","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,24.01,5.0999999999999996,456.36,10.659999999999998]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J0137","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,24.01,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J0137","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J0137","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.61,5.0999999999999996,456.36,10.659999999999998]
["MEDICARE - MEDICARE A&B - HCPCS - J0137","MEDICARE - MEDICARE A&B - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","MEDICARE","MEDICARE A&B","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J0137","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J0137","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,42.63,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J0137","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - Q9967","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,11.043333333333337,0.12,456.36,6.458333333333333]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - Q9967","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - Q9967","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["UNITED - UNITED STANDARD - HCPCS - Q9967","UNITED - UNITED STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED","UNITED STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - Q9967","WORKERS COMP - WORKERS COMP THE HARTFORD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,11.043333333333331,0.12,456.36,6.458333333333333]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - Q9967","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J0137","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,7,5.0999999999999996,456.36,10.659999999999998]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - Q9967","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - Q9967","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - Q9967","ZZZCIGNA - ZZZCIGNA CARELINK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - Q9967","ZZZCIGNA - ZZZCIGNA STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,21.958333333333329,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - Q9967","WORKERS COMP - WORKERS COMP COVE RISK - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,11.043333333333331,0.12,456.36,6.458333333333333]
["AETNA - AETNA MCR SUPP - HCPCS - J0137","AETNA - AETNA MCR SUPP - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","AETNA","AETNA MCR SUPP","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,22.55,5.0999999999999996,456.36,10.659999999999998]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - Q9967","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - Q9967 - LOCM 300-399MG/ML IODINE,1ML","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,11.043333333333337,0.12,456.36,6.458333333333333]
["CCA - ZZZCCA STANDARD - HCPCS - J0137","CCA - ZZZCCA STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CCA","ZZZCCA STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["UNITED - UNITED HP SHIP - HCPCS - Q9967","UNITED - UNITED HP SHIP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","UNITED","UNITED HP SHIP","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0137","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.1000000000000005,5.0999999999999996,456.36,10.659999999999998]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J0137","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J0137 - PR INJ, ACETAMINOPHEN (HIKMA)","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J0137","PR INJ, ACETAMINOPHEN (HIKMA)","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",42.63,5.36,5.0999999999999996,456.36,10.659999999999998]
["AETNA - AETNA MCR SUPP - HCPCS - Q9967","AETNA - AETNA MCR SUPP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","AETNA","AETNA MCR SUPP","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["FALLON - FALLON POS STANDARD - HCPCS - Q9967","FALLON - FALLON POS STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","FALLON","FALLON POS STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,12.916666666666666,0.12,456.36,6.458333333333333]
["BCBS - BCBS INDEMNITY - HCPCS - Q9967","BCBS - BCBS INDEMNITY - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS","BCBS INDEMNITY","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["BCBS - BCBS STANDARD - HCPCS - Q9967","BCBS - BCBS STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS","BCBS STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - Q9967","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - Q9967","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CCA - CCA SCO ONECARE - HCPCS - Q9967","CCA - CCA SCO ONECARE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CCA","CCA SCO ONECARE","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - Q9967","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - Q9967","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["FALLON - FALLON HMO STANDARD - HCPCS - Q9967","FALLON - FALLON HMO STANDARD - Q9967 - LOCM 300-399MG/ML IODINE,1ML","FALLON","FALLON HMO STANDARD","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,12.916666666666666,0.12,456.36,6.458333333333333]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - Q9967","CORRECTIONS - CORRECTIONS ICE INMATE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - Q9967","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["HSN BAD DEBT - HSN BAD DEBT - HCPCS - Q9967","HSN BAD DEBT - HSN BAD DEBT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","HSN BAD DEBT","HSN BAD DEBT","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,456.36000000000007,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS BAY STATE - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS BRADSTON - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - Q9967","TRICARE EAST - TRICARE EAST SELECT - Q9967 - LOCM 300-399MG/ML IODINE,1ML","TRICARE EAST","TRICARE EAST SELECT","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS GARDNER - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - Q9967","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - Q9967 - LOCM 300-399MG/ML IODINE,1ML","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","Q9967","LOCM 300-399MG/ML IODINE,1ML","Q9967 - LOCM 300-399MG/ML IODINE,1ML",25.833333333333332,25.833333333333332,0.12,456.36,6.458333333333333]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J9041","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J9041 - PR INJ., VELCADE 0.1 MG","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J9041","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J9041 - PR INJ., VELCADE 0.1 MG","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J9041","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J9041","ZZZUNITED - ZZZUNITED STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J9041","ZZZAETNA - ZZZAETNA HMO - J9041 - PR INJ., VELCADE 0.1 MG","ZZZAETNA","ZZZAETNA HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,1905.3200000000002,68.569999999999993,4840.46,1423.67]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J9041","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,94.94,68.569999999999993,4840.46,1423.67]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J9041","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J9041 - PR INJ., VELCADE 0.1 MG","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2050.08,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J9041","WORKERS COMP - WORKERS COMP COVE RISK - J9041 - PR INJ., VELCADE 0.1 MG","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J9041","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J9041 - PR INJ., VELCADE 0.1 MG","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2433.9,68.569999999999993,4840.46,1423.67]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J9041","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J9041","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,420.34,68.569999999999993,4840.46,1423.67]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J9041","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["WELLCARE - WELLCARE PPO - HCPCS - J9041","WELLCARE - WELLCARE PPO - J9041 - PR INJ., VELCADE 0.1 MG","WELLCARE","WELLCARE PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.31,68.569999999999993,4840.46,1423.67]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J9041","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J9041 - PR INJ., VELCADE 0.1 MG","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,3207.23,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J9041","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["HSN - HSN TEMPORARY - HCPCS - J9041","HSN - HSN TEMPORARY - J9041 - PR INJ., VELCADE 0.1 MG","HSN","HSN TEMPORARY","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,456.36,68.569999999999993,4840.46,1423.67]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J9041","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J9041 - PR INJ., VELCADE 0.1 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["TUFTS - TUFTS HMO - HCPCS - J9041","TUFTS - TUFTS HMO - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS","TUFTS HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,884.68,68.569999999999993,4840.46,1423.67]
["TUFTS - TUFTS SPIRIT - HCPCS - J9041","TUFTS - TUFTS SPIRIT - J9041 - PR INJ., VELCADE 0.1 MG","TUFTS","TUFTS SPIRIT","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - J9041","CORRECTIONS - CORRECTIONS NAPHCARE - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J9041","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.599999999999994,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J9041","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["FALLON - FALLON PPO STANDARD - HCPCS - J9041","FALLON - FALLON PPO STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","FALLON","FALLON PPO STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,2847.33,68.569999999999993,4840.46,1423.67]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J9041","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J9041","HSN PARTIAL - HSN PARTIAL TEMPORARY - J9041 - PR INJ., VELCADE 0.1 MG","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,456.36,68.569999999999993,4840.46,1423.67]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J9041","CORRECTIONS - CORRECTIONS PLYMOUTH - J9041 - PR INJ., VELCADE 0.1 MG","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J9041","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J9041 - PR INJ., VELCADE 0.1 MG","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,72.45,68.569999999999993,4840.46,1423.67]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J9041","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J9041 - PR INJ., VELCADE 0.1 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,68.569999999999993,68.569999999999993,4840.46,1423.67]
["AETNA - AETNA MCR SUPP - HCPCS - J9041","AETNA - AETNA MCR SUPP - J9041 - PR INJ., VELCADE 0.1 MG","AETNA","AETNA MCR SUPP","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,1905.3200000000002,68.569999999999993,4840.46,1423.67]
["CCA - CCA SCO ONECARE - HCPCS - J9041","CCA - CCA SCO ONECARE - J9041 - PR INJ., VELCADE 0.1 MG","CCA","CCA SCO ONECARE","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,71.989999999999995,68.569999999999993,4840.46,1423.67]
["CIGNA - CIGNA CARELINK - HCPCS - J9041","CIGNA - CIGNA CARELINK - J9041 - PR INJ., VELCADE 0.1 MG","CIGNA","CIGNA CARELINK","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,941.9,68.569999999999993,4840.46,1423.67]
["BCBS - BCBS STANDARD - HCPCS - J9041","BCBS - BCBS STANDARD - J9041 - PR INJ., VELCADE 0.1 MG","BCBS","BCBS STANDARD","HCPCS","J9041","PR INJ., VELCADE 0.1 MG","J9041 - PR INJ., VELCADE 0.1 MG",5694.66,72.45,68.569999999999993,4840.46,1423.67]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - Q5114","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - Q5114 - PR INJ OGIVRI 10 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - Q5114","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - Q5114 - PR INJ OGIVRI 10 MG","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,2201.0650000000005,420.34,5223.6099999999997,1287.4799999999998]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - Q5114","WORKERS COMP - WORKERS COMP THE HARTFORD - Q5114 - PR INJ OGIVRI 10 MG","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - Q5114","ZZZAETNA - ZZZAETNA HMO - Q5114 - PR INJ OGIVRI 10 MG","ZZZAETNA","ZZZAETNA HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,2454.9250000000002,420.34,5223.6099999999997,1287.48]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - Q5114","ZZZCIGNA - ZZZCIGNA CARELINK - Q5114 - PR INJ OGIVRI 10 MG","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1792.8400000000001,420.34,5223.6099999999997,1287.4799999999998]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - Q5114","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - Q5114 - PR INJ OGIVRI 10 MG","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - Q5114","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - Q5114 - PR INJ OGIVRI 10 MG","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - Q5114","ZZZAETNA - ZZZAETNA STUDENT HEALTH - Q5114 - PR INJ OGIVRI 10 MG","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,2724.3,420.34,5223.6099999999997,1287.4799999999998]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - Q5114","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - Q5114 - PR INJ OGIVRI 10 MG","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,420.34,420.34,5223.6099999999997,1287.48]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - Q5114","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - Q5114 - PR INJ OGIVRI 10 MG","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,2201.0650000000001,420.34,5223.6099999999997,1287.48]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - Q5114","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - Q5114 - PR INJ OGIVRI 10 MG","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - Q5114","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - Q5114 - PR INJ OGIVRI 10 MG","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["WELLCARE - WELLCARE STANDARD - HCPCS - Q5114","WELLCARE - WELLCARE STANDARD - Q5114 - PR INJ OGIVRI 10 MG","WELLCARE","WELLCARE STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,1674.9349999999999,420.34,5223.6099999999997,1287.48]
["FALLON SCO - FALLON SCO HMO - HCPCS - Q5114","FALLON SCO - FALLON SCO HMO - Q5114 - PR INJ OGIVRI 10 MG","FALLON SCO","FALLON SCO HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - Q5114","HSN PARTIAL - HSN PARTIAL STANDARD - Q5114 - PR INJ OGIVRI 10 MG","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,456.36,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - Q5114","CORRECTIONS - CORRECTIONS NASHUA - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - Q5114","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - Q5114 - PR INJ OGIVRI 10 MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1610.5874999999999,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - Q5114","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1771.5625,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - Q5114","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - Q5114","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - Q5114","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - Q5114","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - Q5114","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - Q5114 - PR INJ OGIVRI 10 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,2900.4225000000001,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - Q5114","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1691.0374999999999,420.34,5223.6099999999997,1287.4799999999998]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - Q5114","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - Q5114 - PR INJ OGIVRI 10 MG","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1691.0375000000001,420.34,5223.6099999999997,1287.48]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - Q5114","MEDICARE - MEDICARE PART B ONLY - Q5114 - PR INJ OGIVRI 10 MG","MEDICARE","MEDICARE PART B ONLY","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1610.5124999999998,420.34,5223.6099999999997,1287.4799999999998]
["FALLON - FALLON POS STANDARD - HCPCS - Q5114","FALLON - FALLON POS STANDARD - Q5114 - PR INJ OGIVRI 10 MG","FALLON","FALLON POS STANDARD","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,2574.9500000000003,420.34,5223.6099999999997,1287.48]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - Q5114","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - Q5114 - PR INJ OGIVRI 10 MG","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,1610.5125000000003,420.34,5223.6099999999997,1287.48]
["AETNA - AETNA MCR SUPP - HCPCS - Q5114","AETNA - AETNA MCR SUPP - Q5114 - PR INJ OGIVRI 10 MG","AETNA","AETNA MCR SUPP","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,2454.9250000000002,420.34,5223.6099999999997,1287.4799999999998]
["AETNA - AETNA PPO EPO - HCPCS - Q5114","AETNA - AETNA PPO EPO - Q5114 - PR INJ OGIVRI 10 MG","AETNA","AETNA PPO EPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,2454.9250000000002,420.34,5223.6099999999997,1287.4799999999998]
["BCBS - BCBS HMO - HCPCS - Q5114","BCBS - BCBS HMO - Q5114 - PR INJ OGIVRI 10 MG","BCBS","BCBS HMO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,2269.9749999999999,420.34,5223.6099999999997,1287.48]
["CIGNA - CIGNA LOCALPLUS - HCPCS - Q5114","CIGNA - CIGNA LOCALPLUS - Q5114 - PR INJ OGIVRI 10 MG","CIGNA","CIGNA LOCALPLUS","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.8999999999996,4377.4174999999996,420.34,5223.6099999999997,1287.48]
["BCBS - BCBS SHIP PPO - HCPCS - Q5114","BCBS - BCBS SHIP PPO - Q5114 - PR INJ OGIVRI 10 MG","BCBS","BCBS SHIP PPO","HCPCS","Q5114","PR INJ OGIVRI 10 MG","Q5114 - PR INJ OGIVRI 10 MG",5149.9000000000005,2269.9749999999999,420.34,5223.6099999999997,1287.48]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J0750","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J0750 - HIV PREP, FTC/TDF 200/300MG","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,89.98,1.22,456.36,52.63]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J0750","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J0750 - HIV PREP, FTC/TDF 200/300MG","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,1.22,1.22,456.36,52.63]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J7121","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J7121","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,5.5466666666666669,3.84,456.36,3.85]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J7121","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J7121 - PR 5% DEXTROSE IN LAC RINGERS","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["WELLCARE - WELLCARE STANDARD - HCPCS - J7121","WELLCARE - WELLCARE STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","WELLCARE","WELLCARE STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0750","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J0750 - HIV PREP, FTC/TDF 200/300MG","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,420.34,1.22,456.36,52.63]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J7121","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J7121 - PR 5% DEXTROSE IN LAC RINGERS","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J7121","ZZZAETNA - ZZZAETNA PPO-EPO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,8.1466666666666665,3.84,456.36,3.85]
["UNICARE - UNICARE STANDARD - HCPCS - J7121","UNICARE - UNICARE STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","UNICARE","UNICARE STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,11.549999999999999,3.84,456.36,3.85]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J0750","ZZZAETNA - ZZZAETNA HMO - J0750 - HIV PREP, FTC/TDF 200/300MG","ZZZAETNA","ZZZAETNA HMO","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,111.37,1.22,456.36,52.63]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J7121","WORKERS COMP - ZZZWORKERS COMP AIG - J7121 - PR 5% DEXTROSE IN LAC RINGERS","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,6.5799999999999992,3.84,456.36,3.85]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J7121","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J7121 - PR 5% DEXTROSE IN LAC RINGERS","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["UNITED - UNITED DEFINITY HRA - HCPCS - J7121","UNITED - UNITED DEFINITY HRA - J7121 - PR 5% DEXTROSE IN LAC RINGERS","UNITED","UNITED DEFINITY HRA","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J7121","ZZZAETNA - ZZZAETNA HMO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","ZZZAETNA","ZZZAETNA HMO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,8.1466666666666665,3.84,456.36,3.8499999999999996]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J7121","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J7121 - PR 5% DEXTROSE IN LAC RINGERS","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,420.34,3.84,456.36,3.85]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J7121","TUFTS MEDICARE - TUFTS MEDICARE HMO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J7121","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J7121 - PR 5% DEXTROSE IN LAC RINGERS","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J7121","WORKERS COMP - WORKERS COMP MBTA - J7121 - PR 5% DEXTROSE IN LAC RINGERS","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,6.5799999999999992,3.84,456.36,3.8499999999999996]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J7121","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J7121 - PR 5% DEXTROSE IN LAC RINGERS","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,6.5799999999999992,3.84,456.36,3.85]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7121","FALLON - FALLON COMMUNITY PLAN - J7121 - PR 5% DEXTROSE IN LAC RINGERS","FALLON","FALLON COMMUNITY PLAN","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,7.7,3.84,456.36,3.8499999999999996]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J7121","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["FALLON - FALLON HMO STANDARD - HCPCS - J0750","FALLON - FALLON HMO STANDARD - J0750 - HIV PREP, FTC/TDF 200/300MG","FALLON","FALLON HMO STANDARD","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,105.27,1.22,456.36,52.63]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J7121","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J7121 - PR 5% DEXTROSE IN LAC RINGERS","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J7121","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J7121","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["TUFTS - TUFTS CARELINK - HCPCS - J7121","TUFTS - TUFTS CARELINK - J7121 - PR 5% DEXTROSE IN LAC RINGERS","TUFTS","TUFTS CARELINK","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,9.5933333333333337,3.84,456.36,3.8499999999999996]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0750","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J0750 - HIV PREP, FTC/TDF 200/300MG","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,1.22,1.22,456.36,52.63]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J7121","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J7121","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["TUFTS - TUFTS SELECT - HCPCS - J7121","TUFTS - TUFTS SELECT - J7121 - PR 5% DEXTROSE IN LAC RINGERS","TUFTS","TUFTS SELECT","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,9,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J7121","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J7121","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J7121","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J7121","OXFORD HEALTH - OXFORD HEALTH STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J7121","HSN PARTIAL - HSN PARTIAL STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,456.35999999999996,3.84,456.36,3.85]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J7121","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,11.623333333333333,3.84,456.36,3.8499999999999996]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J7121","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.8499999999999996]
["AETNA - AETNA MCR SUPP - HCPCS - J0750","AETNA - AETNA MCR SUPP - J0750 - HIV PREP, FTC/TDF 200/300MG","AETNA","AETNA MCR SUPP","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,111.37,1.22,456.36,52.63]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J7121","CORRECTIONS - CORRECTIONS BRISTOL - J7121 - PR 5% DEXTROSE IN LAC RINGERS","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,15.396666666666667,3.84,456.36,3.85]
["BCBS - BCBS STANDARD - HCPCS - J7121","BCBS - BCBS STANDARD - J7121 - PR 5% DEXTROSE IN LAC RINGERS","BCBS","BCBS STANDARD","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",15.396666666666667,11.623333333333335,3.84,456.36,3.85]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J0750","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J0750 - HIV PREP, FTC/TDF 200/300MG","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,1.37,1.22,456.36,52.63]
["BCBS - BCBS POS - HCPCS - J0750","BCBS - BCBS POS - J0750 - HIV PREP, FTC/TDF 200/300MG","BCBS","BCBS POS","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,1.37,1.22,456.36,52.63]
["CIGNA - CIGNA CARELINK - HCPCS - J0750","CIGNA - CIGNA CARELINK - J0750 - HIV PREP, FTC/TDF 200/300MG","CIGNA","CIGNA CARELINK","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,95.92,1.22,456.36,52.63]
["BCBS - BCBS STANDARD - HCPCS - J0750","BCBS - BCBS STANDARD - J0750 - HIV PREP, FTC/TDF 200/300MG","BCBS","BCBS STANDARD","HCPCS","J0750","HIV PREP, FTC/TDF 200/300MG","J0750 - HIV PREP, FTC/TDF 200/300MG",210.53,1.37,1.22,456.36,52.63]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0688","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J0688","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,4.68,4.32,456.36,3.25]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J0688","UNITED - UNITED HP STUDENT HEALTH - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J0688","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J0688","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,420.34,4.32,456.36,3.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J0688","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J0688","WORKERS COMP - WORKERS COMP CCMSI - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,5.55,4.32,456.36,3.25]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J0688","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,5.2,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0688","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,420.34,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J0688","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,5.55,4.32,456.36,3.25]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J0688","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,5.55,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0688","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,420.34,4.32,456.36,3.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J0688","ZZZCIGNA - ZZZCIGNA STANDARD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,11.04,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J0688","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J0688","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["FALLON - FALLON POS STANDARD - HCPCS - J0688","FALLON - FALLON POS STANDARD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","FALLON","FALLON POS STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,6.5,4.32,456.36,3.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0688","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,420.34,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J0688","CORRECTIONS - ZZZCORRECTIONS CONCORD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["MEDICARE - MEDICARE A&B - HCPCS - J0688","MEDICARE - MEDICARE A&B - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","MEDICARE","MEDICARE A&B","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J0688","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J0688","TRICARE EAST - TRICARE EAST PRIME (HMO) - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J0688","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J0688","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0688","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["TUFTS - TUFTS PPO - HCPCS - J0688","TUFTS - TUFTS PPO - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","TUFTS","TUFTS PPO","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,5.92,4.32,456.36,3.25]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J0688","OXFORD HEALTH - OXFORD HEALTH STANDARD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - HCPCS - J0688","SENIOR WHOLE HEALTH - SENIOR WHOLE HEALTH SCO STANDARD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0688","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J2270","ZZZAETNA - ZZZAETNA MCR SUPP - J2270 - PR MORPHINE SULFATE INJECTION","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,16.579999999999998,11.28,456.36,7.84]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - J2270","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - J2270 - PR MORPHINE SULFATE INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - J2270","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - J2270 - PR MORPHINE SULFATE INJECTION","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,13.39,11.28,456.36,7.84]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J2270","ZZZAETNA - ZZZAETNA PPO-EPO - J2270 - PR MORPHINE SULFATE INJECTION","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,16.579999999999998,11.28,456.36,7.84]
["CCA - ZZZCCA STANDARD - HCPCS - J0688","CCA - ZZZCCA STANDARD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CCA","ZZZCCA STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J0688","CCA MEDICARE PREFERRED - ZZZCCA - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J2270","WORKERS COMP - WORKERS COMP COVE RISK - J2270 - PR MORPHINE SULFATE INJECTION","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,13.39,11.28,456.36,7.84]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - J0688","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J2270","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J2270 - PR MORPHINE SULFATE INJECTION","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,13.39,11.28,456.36,7.84]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J2270","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J2270 - PR MORPHINE SULFATE INJECTION","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,13.39,11.28,456.36,7.84]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J0688","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["WELLCARE - WELLCARE STANDARD - HCPCS - J2270","WELLCARE - WELLCARE STANDARD - J2270 - PR MORPHINE SULFATE INJECTION","WELLCARE","WELLCARE STANDARD","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2270","ZZZCIGNA - CIGNA LOCALPLUS - J2270 - PR MORPHINE SULFATE INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,26.64,11.28,456.36,7.84]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J2270","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J2270 - PR MORPHINE SULFATE INJECTION","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2270","ZZZCIGNA - ZZZCIGNA CARELINK - J2270 - PR MORPHINE SULFATE INJECTION","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J0688","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J0688 - INJ CEFAZOLIN SODIUM, HIKMA","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J0688","INJ CEFAZOLIN SODIUM, HIKMA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",12.99,12.99,4.32,456.36,3.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2270","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J2270 - PR MORPHINE SULFATE INJECTION","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2270","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J2270 - PR MORPHINE SULFATE INJECTION","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,420.34,11.28,456.36,7.84]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J2270","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J2270 - PR MORPHINE SULFATE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,17.649999999999999,11.28,456.36,7.84]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J2270","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J2270 - PR MORPHINE SULFATE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2270","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J2270 - PR MORPHINE SULFATE INJECTION","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["MEDICARE - MEDICARE A&B - HCPCS - J2270","MEDICARE - MEDICARE A&B - J2270 - PR MORPHINE SULFATE INJECTION","MEDICARE","MEDICARE A&B","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J2270","CCA MEDICARE PREFERRED - ZZZCCA - J2270 - PR MORPHINE SULFATE INJECTION","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CIGNA - CIGNA CARELINK - HCPCS - J2270","CIGNA - CIGNA CARELINK - J2270 - PR MORPHINE SULFATE INJECTION","CIGNA","CIGNA CARELINK","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J2270","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J2270 - PR MORPHINE SULFATE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2270","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J2270 - PR MORPHINE SULFATE INJECTION","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,17.649999999999999,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J2270","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J2270 - PR MORPHINE SULFATE INJECTION","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2270","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J2270 - PR MORPHINE SULFATE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2270","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J2270 - PR MORPHINE SULFATE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J2270","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J2270 - PR MORPHINE SULFATE INJECTION","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J2598","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - HCPCS - J8540","CORRECTIONS - CORRECTIONS NORFOLK CTY CORR - J8540 - PR ORAL DEXAMETHASONE","CORRECTIONS","CORRECTIONS NORFOLK CTY CORR","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J2270","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J2270 - PR MORPHINE SULFATE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J0702","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J1250","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS PLYMOUTH CORR - HCPCS - J3301","CORRECTIONS - CORRECTIONS PLYMOUTH CORR - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","CORRECTIONS PLYMOUTH CORR","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J2270","MEDICARE - MEDICARE PART A ONLY - J2270 - PR MORPHINE SULFATE INJECTION","MEDICARE","MEDICARE PART A ONLY","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2270","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J2270 - PR MORPHINE SULFATE INJECTION","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2270","CORRECTIONS - ZZZCORRECTIONS CEDAR - J2270 - PR MORPHINE SULFATE INJECTION","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J2270","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J2270 - PR MORPHINE SULFATE INJECTION","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,31.34,11.28,456.36,7.84]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2270","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J2270 - PR MORPHINE SULFATE INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J2270","PR MORPHINE SULFATE INJECTION","J2270 - PR MORPHINE SULFATE INJECTION",31.34,420.34,11.28,456.36,7.84]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J1817","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J1817 - PR INSULIN FOR INSULIN PUMP USE","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J0131","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J0131 - PR ACETAMINOPHEN INJECTION","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,22.55,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE HMO - HCPCS - J1817","WELLCARE - WELLCARE HMO - J1817 - PR INSULIN FOR INSULIN PUMP USE","WELLCARE","WELLCARE HMO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - J0131","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - J0131 - PR ACETAMINOPHEN INJECTION","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,42.63,5.0999999999999996,456.36,10.66]
["ZZZAETNA - ZZZAETNA STUDENT HEALTH - HCPCS - J1817","ZZZAETNA - ZZZAETNA STUDENT HEALTH - J1817 - PR INSULIN FOR INSULIN PUMP USE","ZZZAETNA","ZZZAETNA STUDENT HEALTH","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,35.67,24.27,456.36,16.86]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - C9113","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J0131","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J0131 - PR ACETAMINOPHEN INJECTION","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J0131","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J0131 - PR ACETAMINOPHEN INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J2930","UNITED - UNITED HP STUDENT HEALTH - J2930 - PR METHYLPREDNISOLONE INJECTION","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["UNITED - UNITED HP SHIP - HCPCS - J2930","UNITED - UNITED HP SHIP - J2930 - PR METHYLPREDNISOLONE INJECTION","UNITED","UNITED HP SHIP","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - S0020","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.96,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - J2930","WORKERS COMP - WORKERS COMP GUARD INSURANCE - J2930 - PR METHYLPREDNISOLONE INJECTION","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["UBH HPHC - UBH HPHC - HCPCS - J1817","UBH HPHC - UBH HPHC - J1817 - PR INSULIN FOR INSULIN PUMP USE","UBH HPHC","UBH HPHC","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - S0020","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - S0020 - PR INJECTION, BUPIVICAINE HYDRO","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J0131","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J0131 - PR ACETAMINOPHEN INJECTION","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - S0020","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - S0020 - PR INJECTION, BUPIVICAINE HYDRO","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,420.34,2.4900000000000002,456.36,1.73]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J0131","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J0131 - PR ACETAMINOPHEN INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - J2930","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - J2930 - PR METHYLPREDNISOLONE INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J1817","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J1817 - PR INSULIN FOR INSULIN PUMP USE","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,26.97,24.27,456.36,16.86]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2930","ZZZCCA ONECARE - ZZZCCA ONECARE - J2930 - PR METHYLPREDNISOLONE INJECTION","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["UNITED - UNITED HP SHIP - HCPCS - J7121","UNITED - UNITED HP SHIP - J7121 - PR 5% DEXTROSE IN LAC RINGERS","UNITED","UNITED HP SHIP","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2930","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J2930 - PR METHYLPREDNISOLONE INJECTION","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - C9113","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP GUARD INSURANCE - HCPCS - S0020","WORKERS COMP - WORKERS COMP GUARD INSURANCE - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WORKERS COMP","WORKERS COMP GUARD INSURANCE","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J1817","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J1817 - PR INSULIN FOR INSULIN PUMP USE","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WELLCARE - WELLCARE HMO - HCPCS - S0020","WELLCARE - WELLCARE HMO - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WELLCARE","WELLCARE HMO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J2930","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J2930 - PR METHYLPREDNISOLONE INJECTION","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1817","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J1817 - PR INSULIN FOR INSULIN PUMP USE","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,420.34,24.27,456.36,16.86]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J0131","ZZZCIGNA - CIGNA LOCALPLUS - J0131 - PR ACETAMINOPHEN INJECTION","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,36.24,5.0999999999999996,456.36,10.66]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - C9113","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - S0020","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.96,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - J0131","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - J0131 - PR ACETAMINOPHEN INJECTION","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,18.22,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - C9113","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,420.34,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J0131","WORKERS COMP - ZZZWORKERS COMP AIG - J0131 - PR ACETAMINOPHEN INJECTION","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,18.22,5.0999999999999996,456.36,10.66]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J7121","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - S0020","ZZZCIGNA - CIGNA LOCALPLUS - S0020 - PR INJECTION, BUPIVICAINE HYDRO","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,5.89,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - C9113","WORKERS COMP - WORKERS COMP CITY OF BOSTON - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,7.59,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - S0020","WORKERS COMP - ZZZWORKERS COMP AIG - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J7131","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J7131 - PR HYPERTONIC SALINE SOL","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1817","ZZZCIGNA - ZZZCIGNA CARELINK - J1817 - PR INSULIN FOR INSULIN PUMP USE","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J1817","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J1817 - PR INSULIN FOR INSULIN PUMP USE","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,28.82,24.27,456.36,16.86]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J2930","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J2930 - PR METHYLPREDNISOLONE INJECTION","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["WORKERS COMP - WORKERS COMP STANDARD - HCPCS - J2930","WORKERS COMP - WORKERS COMP STANDARD - J2930 - PR METHYLPREDNISOLONE INJECTION","WORKERS COMP","WORKERS COMP STANDARD","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,34.299999999999997,24.44,456.36,20.07]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J0131","ZZZCIGNA - ZZZCIGNA STANDARD - J0131 - PR ACETAMINOPHEN INJECTION","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,36.24,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - C9113","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,7.59,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - S0020","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J1817","ZZZCIGNA - ZZZCIGNA STANDARD - J1817 - PR INSULIN FOR INSULIN PUMP USE","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,57.32,24.27,456.36,16.86]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J1817","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - J1817 - PR INSULIN FOR INSULIN PUMP USE","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - S0020","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZUNITED - ZZZUNITED DEFINITY HRA - HCPCS - C9113","ZZZUNITED - ZZZUNITED DEFINITY HRA - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","ZZZUNITED","ZZZUNITED DEFINITY HRA","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - S0020","ZZZCIGNA - ZZZCIGNA STANDARD - S0020 - PR INJECTION, BUPIVICAINE HYDRO","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,5.89,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J0131","WORKERS COMP - WORKERS COMP COVE RISK - J0131 - PR ACETAMINOPHEN INJECTION","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,18.22,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE PPO - HCPCS - J0131","WELLCARE - WELLCARE PPO - J0131 - PR ACETAMINOPHEN INJECTION","WELLCARE","WELLCARE PPO","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.3,5.0999999999999996,456.36,10.66]
["TUFTS MEDICARE - TUFTS MEDICARE HMO - HCPCS - J1817","TUFTS MEDICARE - TUFTS MEDICARE HMO - J1817 - PR INSULIN FOR INSULIN PUMP USE","TUFTS MEDICARE","TUFTS MEDICARE HMO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - S0020","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - S0020 - PR INJECTION, BUPIVICAINE HYDRO","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,420.34,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - S0020","WORKERS COMP - WORKERS COMP THE HARTFORD - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.96,2.4900000000000002,456.36,1.73]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - S0020","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - S0020 - PR INJECTION, BUPIVICAINE HYDRO","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J1817","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J1817 - PR INSULIN FOR INSULIN PUMP USE","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J0131","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J0131 - PR ACETAMINOPHEN INJECTION","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - C9113","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - C9113","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1817","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J1817 - PR INSULIN FOR INSULIN PUMP USE","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J7131","UNITED - UNITED PASSPORT CONNECT - J7131 - PR HYPERTONIC SALINE SOL","UNITED","UNITED PASSPORT CONNECT","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - C9113","ZZZUNITED - ZZZUNITED STANDARD - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - HCPCS - S0020","WORKERS COMP - ZZZWORKERS COMP COOK AND COMPANY - S0020 - PR INJECTION, BUPIVICAINE HYDRO","WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,2.96,2.4900000000000002,456.36,1.73]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J0131","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J0131 - PR ACETAMINOPHEN INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,42.63,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - C9113","CORRECTIONS - ZZZCORRECTIONS CONCORD - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J2930","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J2930 - PR METHYLPREDNISOLONE INJECTION","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - S0020","CORRECTIONS - ZZZCORRECTIONS NORFOLK - S0020 - PR INJECTION, BUPIVICAINE HYDRO","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["FALLON - FALLON POS STANDARD - HCPCS - C9113","FALLON - FALLON POS STANDARD - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","FALLON","FALLON POS STANDARD","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,8.89,6.4,456.36,4.4400000000000004]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J0131","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J0131 - PR ACETAMINOPHEN INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,42.63,5.0999999999999996,456.36,10.66]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - C9113","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,10.01,6.4,456.36,4.4400000000000004]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J0131","MEDICARE - MEDICARE PART A ONLY - J0131 - PR ACETAMINOPHEN INJECTION","MEDICARE","MEDICARE PART A ONLY","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J2930","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J2930 - PR METHYLPREDNISOLONE INJECTION","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - J2930","CORRECTIONS - ZZZCORRECTIONS NASHUA - J2930 - PR METHYLPREDNISOLONE INJECTION","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J2930","CORRECTIONS - ZZZCORRECTIONS CONCORD - J2930 - PR METHYLPREDNISOLONE INJECTION","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - J7121","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - J7121 - PR 5% DEXTROSE IN LAC RINGERS","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J1817","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J7121","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55]
["MEDICARE - MEDICARE PART B ONLY - HCPCS - J0131","MEDICARE - MEDICARE PART B ONLY - J0131 - PR ACETAMINOPHEN INJECTION","MEDICARE","MEDICARE PART B ONLY","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J2930","HSN PARTIAL - HSN PARTIAL TEMPORARY - J2930 - PR METHYLPREDNISOLONE INJECTION","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,456.36,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - C9113","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - J0131","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - J0131 - PR ACETAMINOPHEN INJECTION","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J0131","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J0131 - PR ACETAMINOPHEN INJECTION","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.36,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - HCPCS - J2930","CORRECTIONS - ZZZCORRECTIONS N CENTRAL CORR - J2930 - PR METHYLPREDNISOLONE INJECTION","CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J2930","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J2930 - PR METHYLPREDNISOLONE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J1817","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J1817","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J1817 - PR INSULIN FOR INSULIN PUMP USE","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,37.979999999999997,24.27,456.36,16.86]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J1817","CORRECTIONS - ZZZCORRECTIONS CEDAR - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J0131","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J0131 - PR ACETAMINOPHEN INJECTION","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.36,5.0999999999999996,456.36,10.66]
["FALLON - FALLON POS STANDARD - HCPCS - J2930","FALLON - FALLON POS STANDARD - J2930 - PR METHYLPREDNISOLONE INJECTION","FALLON","FALLON POS STANDARD","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,40.130000000000003,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J0131","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J0131 - PR ACETAMINOPHEN INJECTION","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.36,5.0999999999999996,456.36,10.66]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J1817","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J2930","CORRECTIONS - CORRECTIONS ICE INMATE - J2930 - PR METHYLPREDNISOLONE INJECTION","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J1817","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J1817 - PR INSULIN FOR INSULIN PUMP USE","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["FALLON SCO - FALLON SCO HMO - HCPCS - C9113","FALLON SCO - FALLON SCO HMO - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","FALLON SCO","FALLON SCO HMO","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["TUFTS - TUFTS SPIRIT - HCPCS - S0020","TUFTS - TUFTS SPIRIT - S0020 - PR INJECTION, BUPIVICAINE HYDRO","TUFTS","TUFTS SPIRIT","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J1817","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J1817 - PR INSULIN FOR INSULIN PUMP USE","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - S0020","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - S0020 - PR INJECTION, BUPIVICAINE HYDRO","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J2930","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J2930 - PR METHYLPREDNISOLONE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2930","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J2930 - PR METHYLPREDNISOLONE INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J1817","OXFORD HEALTH - OXFORD HEALTH STANDARD - J1817 - PR INSULIN FOR INSULIN PUMP USE","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J2930","OXFORD HEALTH - OXFORD HEALTH STANDARD - J2930 - PR METHYLPREDNISOLONE INJECTION","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J7121","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J7121 - PR 5% DEXTROSE IN LAC RINGERS","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J7121","PR 5% DEXTROSE IN LAC RINGERS","J7121 - PR 5% DEXTROSE IN LAC RINGERS",14.21,14.21,5.12,456.36,3.55]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - S0020","HSN CONFIDENTIAL - HSN CONFIDENTIAL - S0020 - PR INJECTION, BUPIVICAINE HYDRO","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,456.36,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - HCPCS - C9113","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE POS - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J7131","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J7131 - PR HYPERTONIC SALINE SOL","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64]
["TUFTS - TUFTS CARELINK - HCPCS - J2930","TUFTS - TUFTS CARELINK - J2930 - PR METHYLPREDNISOLONE INJECTION","TUFTS","TUFTS CARELINK","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - HCPCS - J7131","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE HMO - J7131 - PR HYPERTONIC SALINE SOL","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J2930","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J2930 - PR METHYLPREDNISOLONE INJECTION","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - S0020","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - S0020 - PR INJECTION, BUPIVICAINE HYDRO","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,3.9,2.4900000000000002,456.36,1.73]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - S0020","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - S0020 - PR INJECTION, BUPIVICAINE HYDRO","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - C9113","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - C9113","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - S0020","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - S0020 - PR INJECTION, BUPIVICAINE HYDRO","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J0131","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J0131 - PR ACETAMINOPHEN INJECTION","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.36,5.0999999999999996,456.36,10.66]
["HSN PARTIAL - HSN PARTIAL STANDARD - HCPCS - J2930","HSN PARTIAL - HSN PARTIAL STANDARD - J2930 - PR METHYLPREDNISOLONE INJECTION","HSN PARTIAL","HSN PARTIAL STANDARD","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,456.36,24.44,456.36,20.07]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - J1817","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - HCPCS - S0020","FALLON MEDICARE MANAGED - FALLON MCR MNG HMO - S0020 - PR INJECTION, BUPIVICAINE HYDRO","FALLON MEDICARE MANAGED","FALLON MCR MNG HMO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - C9113","HSN PARTIAL - HSN PARTIAL TEMPORARY - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,456.36,6.4,456.36,4.4400000000000004]
["TUFTS - TUFTS SELECT - HCPCS - J0131","TUFTS - TUFTS SELECT - J0131 - PR ACETAMINOPHEN INJECTION","TUFTS","TUFTS SELECT","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,42.63,5.0999999999999996,456.36,10.66]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J0131","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J0131 - PR ACETAMINOPHEN INJECTION","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,42.63,5.0999999999999996,456.36,10.66]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - S0020","CORRECTIONS - CORRECTIONS NORFOLK - S0020 - PR INJECTION, BUPIVICAINE HYDRO","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["TUFTS - TUFTS SPIRIT - HCPCS - J0131","TUFTS - TUFTS SPIRIT - J0131 - PR ACETAMINOPHEN INJECTION","TUFTS","TUFTS SPIRIT","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["TRICARE EAST - TRICARE EAST PRIME (HMO) - HCPCS - J0131","TRICARE EAST - TRICARE EAST PRIME (HMO) - J0131 - PR ACETAMINOPHEN INJECTION","TRICARE EAST","TRICARE EAST PRIME (HMO)","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,42.63,5.0999999999999996,456.36,10.66]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J7131","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J7131 - PR HYPERTONIC SALINE SOL","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J7131","PR HYPERTONIC SALINE SOL","J7131 - PR HYPERTONIC SALINE SOL",2.56,2.56,0.92,456.36,0.64]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - C9113","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J2930","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J2930 - PR METHYLPREDNISOLONE INJECTION","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - C9113","CORRECTIONS - ZZZCORRECTIONS BRADSTON - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1817","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - C9113","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J2930","CORRECTIONS - CORRECTIONS NORFOLK - J2930 - PR METHYLPREDNISOLONE INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J1817","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - J1817","TRICARE EAST - TRICARE EAST SELECT - J1817 - PR INSULIN FOR INSULIN PUMP USE","TRICARE EAST","TRICARE EAST SELECT","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["CIGNA - CIGNA STANDARD - HCPCS - S0020","CIGNA - CIGNA STANDARD - S0020 - PR INJECTION, BUPIVICAINE HYDRO","CIGNA","CIGNA STANDARD","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,5.89,2.4900000000000002,456.36,1.73]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J1250","ZZZAETNA - ZZZAETNA PPO-EPO - J1250 - PR INJ DOBUTAMINE HCL/250 MG","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.76,3.24,456.36,2.25]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J3010","ZZZAETNA - ZZZAETNA PPO-EPO - J3010 - PR FENTANYL CITRATE INJECITON","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.28000000000000003,0.19,456.36,0.13]
["ZZZAETNA - ZZZAETNA PPO-EPO - HCPCS - J7307","ZZZAETNA - ZZZAETNA PPO-EPO - J7307 - ETONOGESTREL IMPLANT SYSTEM","ZZZAETNA","ZZZAETNA PPO-EPO","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1673.23,420.34,2688.55,790.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J2598","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J7608","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J7608 - ACETYLCYSTEINE NON-COMP UNIT","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,5.66,4.7699999999999996,456.36,3.31]
["WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - HCPCS - J2598","WORKERS COMP - WORKERS COMP ST PAUL TRAVELERS INS - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - HCPCS - J1250","WORKERS COMP - WORKERS COMP SEDGWICK CLAIMS MANAGEMENT - J1250 - PR INJ DOBUTAMINE HCL/250 MG","WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,3.85,3.24,456.36,2.25]
["CCA - CCA SCO STANDARD - HCPCS - C9113","CCA - CCA SCO STANDARD - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","CCA","CCA SCO STANDARD","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J2598","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,64.53,36.299999999999997,456.36,37.75]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - C9257","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - C9257 - PR BEVACIZUMAB INJECTION","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,14.96,1.68,456.36,8.75]
["BCBS - BCBS INDEMNITY - HCPCS - S0020","BCBS - BCBS INDEMNITY - S0020 - PR INJECTION, BUPIVICAINE HYDRO","BCBS","BCBS INDEMNITY","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,4.4800000000000004,2.4900000000000002,456.36,1.73]
["BCBS - BCBS PPO - HCPCS - S0020","BCBS - BCBS PPO - S0020 - PR INJECTION, BUPIVICAINE HYDRO","BCBS","BCBS PPO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,4.4800000000000004,2.4900000000000002,456.36,1.73]
["ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - HCPCS - J7608","ZZZBU EMPLOYEE WORK COMP - ZZZBU EMPLOYEE WORK COMP STANDARD - J7608 - ACETYLCYSTEINE NON-COMP UNIT","ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,5.66,4.7699999999999996,456.36,3.31]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - J2598","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J1250","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J0702","ZZZCCA ONECARE - ZZZCCA ONECARE - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["ZZZCCA ONECARE - ZZZCCA ONECARE - HCPCS - J2598","ZZZCCA ONECARE - ZZZCCA ONECARE - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","ZZZCCA ONECARE","ZZZCCA ONECARE","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - J3010","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CIGNA - CIGNA LOCALPLUS - HCPCS - S0020","CIGNA - CIGNA LOCALPLUS - S0020 - PR INJECTION, BUPIVICAINE HYDRO","CIGNA","CIGNA LOCALPLUS","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,5.89,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J3301","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,6.41,0.98,456.36,3.75]
["ZZZCCA ONECARE - ZZZCCA SCO ONECARE - HCPCS - J3010","ZZZCCA ONECARE - ZZZCCA SCO ONECARE - J3010 - PR FENTANYL CITRATE INJECITON","ZZZCCA ONECARE","ZZZCCA SCO ONECARE","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J0702","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,53.85,7.07,456.36,31.5]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J7307","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J7307 - ETONOGESTREL IMPLANT SYSTEM","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1351.87,420.34,2688.55,790.75]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - P9047","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,79.92,50.13,456.36,46.75]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J2598","ZZZCIGNA - CIGNA LOCALPLUS - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,128.34,36.299999999999997,456.36,37.75]
["ZZZCIGNA - CIGNA LOCALPLUS - HCPCS - J7307","ZZZCIGNA - CIGNA LOCALPLUS - J7307 - ETONOGESTREL IMPLANT SYSTEM","ZZZCIGNA","CIGNA LOCALPLUS","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,2688.55,420.34,2688.55,790.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - C9257","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - C9257 - PR BEVACIZUMAB INJECTION","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,14.96,1.68,456.36,8.75]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - A9576","ZZZCIGNA - ZZZCIGNA CARELINK - A9576 - INJ PROHANCE MULTIPACK","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J1250","ZZZCIGNA - ZZZCIGNA CARELINK - J1250 - PR INJ DOBUTAMINE HCL/250 MG","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.0999999999999996,3.24,456.36,2.25]
["ZZZCIGNA - ZZZCIGNA CARELINK - HCPCS - J2598","ZZZCIGNA - ZZZCIGNA CARELINK - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","ZZZCIGNA","ZZZCIGNA CARELINK","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,150.99,36.299999999999997,456.36,37.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J0131","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J0131 - PR ACETAMINOPHEN INJECTION","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,7,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - P9047","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,79.92,50.13,456.36,46.75]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - A9576","ZZZCIGNA - ZZZCIGNA STANDARD - A9576 - INJ PROHANCE MULTIPACK","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,4.25,1.58,456.36,1.25]
["WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - HCPCS - Q0249","WORKERS COMP - WORKERS COMP ATLANTIC CHARTER INSURANCE - Q0249 - TOCILIZUMAB FOR COVID-19","WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,3.85,3.24,456.36,2.25]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J1250","WORKERS COMP - WORKERS COMP CCMSI - J1250 - PR INJ DOBUTAMINE HCL/250 MG","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,3.85,3.24,456.36,2.25]
["ZZZCIGNA - ZZZCIGNA STANDARD - HCPCS - J7307","ZZZCIGNA - ZZZCIGNA STANDARD - J7307 - ETONOGESTREL IMPLANT SYSTEM","ZZZCIGNA","ZZZCIGNA STANDARD","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,2688.55,420.34,2688.55,790.75]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - P9047","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J7307","ZZZAETNA - ZZZAETNA MCR SUPP - J7307 - ETONOGESTREL IMPLANT SYSTEM","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1673.23,420.34,2688.55,790.75]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J0702","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,53.85,7.07,456.36,31.5]
["ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - HCPCS - J3301","ZZZCITY OF BOSTON WORK COMP - ZZZCITY OF BOSTON WORK COMP - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,6.41,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J1817","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J1817 - PR INSULIN FOR INSULIN PUMP USE","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J3010","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J3010 - PR FENTANYL CITRATE INJECITON","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.22,0.19,456.36,0.13]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - Q0249","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - Q0249 - TOCILIZUMAB FOR COVID-19","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,3.85,3.24,456.36,2.25]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - HCPCS - J1250","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND - COVID19 HRSA UNINSURED TREATMENT FUND - J1250 - PR INJ DOBUTAMINE HCL/250 MG","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["BCBS - BCBS POS - HCPCS - J2930","BCBS - BCBS POS - J2930 - PR METHYLPREDNISOLONE INJECTION","BCBS","BCBS POS","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,34.64,24.44,456.36,20.07]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3010","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J3010 - PR FENTANYL CITRATE INJECITON","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J0702","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J2598","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,150.99,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - HCPCS - J7307","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC PPO - J7307 - ETONOGESTREL IMPLANT SYSTEM","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1114.33,420.34,2688.55,790.75]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J2598","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - A9576","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - A9576 - INJ PROHANCE MULTIPACK","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - A9576","WORKERS COMP - WORKERS COMP THE HARTFORD - A9576 - INJ PROHANCE MULTIPACK","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,2.14,1.58,456.36,1.25]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - J3010","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - J3010 - PR FENTANYL CITRATE INJECITON","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["WELLCARE - WELLCARE PPO - HCPCS - C9257","WELLCARE - WELLCARE PPO - C9257 - PR BEVACIZUMAB INJECTION","WELLCARE","WELLCARE PPO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.93,1.68,456.36,8.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - HCPCS - P9047","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC SELECT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,52.45,50.13,456.36,46.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - C9257","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - C9257 - PR BEVACIZUMAB INJECTION","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J2598","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - HCPCS - J3590","WORKERS COMP - ZZZWORKERS COMP BROADSPIRE - J3590 - PR UNCLASSIFIED BIOLOGICS","WORKERS COMP","ZZZWORKERS COMP BROADSPIRE","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,520.57000000000005,420.34,1218,304.5]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - HCPCS - J8540","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC BMC TIERED HMO - J8540 - PR ORAL DEXAMETHASONE","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - HCPCS - J0702","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG POS - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J1817","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J1817 - PR INSULIN FOR INSULIN PUMP USE","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J2598","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,150.99,36.299999999999997,456.36,37.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J3301","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - HCPCS - J8540","ZZZHEALTH PLANS INC - ZZZHEALTH PLANS INC STANDARD - J8540 - PR ORAL DEXAMETHASONE","ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J3590","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J3590 - PR UNCLASSIFIED BIOLOGICS","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,520.57000000000005,420.34,1218,304.5]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J0583","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - J0583 - PR BIVALIRUDIN","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - HCPCS - J3010","ZZZRAILROAD MEDICARE - ZZZRAILROAD MEDICARE  RAILROAD - J3010 - PR FENTANYL CITRATE INJECITON","ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J0702","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,53.85,7.07,456.36,31.5]
["WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - HCPCS - J3010","WORKERS COMP - WORKERS COMP BOSTON POLICE DEPARTMENT - J3010 - PR FENTANYL CITRATE INJECITON","WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.22,0.19,456.36,0.13]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3590","ZZZAETNA - ZZZAETNA HMO - J3590 - PR UNCLASSIFIED BIOLOGICS","ZZZAETNA","ZZZAETNA HMO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,644.32000000000005,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP THE HARTFORD - HCPCS - J2598","WORKERS COMP - WORKERS COMP THE HARTFORD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WORKERS COMP","WORKERS COMP THE HARTFORD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,64.53,36.299999999999997,456.36,37.75]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - Q0249","ZZZAETNA - ZZZAETNA HMO - Q0249 - TOCILIZUMAB FOR COVID-19","ZZZAETNA","ZZZAETNA HMO","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,4.76,3.24,456.36,2.25]
["WORKERS COMP - WORKERS COMP CITY OF BOSTON - HCPCS - J1250","WORKERS COMP - WORKERS COMP CITY OF BOSTON - J1250 - PR INJ DOBUTAMINE HCL/250 MG","WORKERS COMP","WORKERS COMP CITY OF BOSTON","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,3.85,3.24,456.36,2.25]
["CIGNA - CIGNA CARELINK - HCPCS - J0131","CIGNA - CIGNA CARELINK - J0131 - PR ACETAMINOPHEN INJECTION","CIGNA","CIGNA CARELINK","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,42.63,5.0999999999999996,456.36,10.66]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J3010","ZZZUNITED - ZZZUNITED HP SHIP - J3010 - PR FENTANYL CITRATE INJECITON","ZZZUNITED","ZZZUNITED HP SHIP","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["ZZZUNITED - ZZZUNITED HP SHIP - HCPCS - J7608","ZZZUNITED - ZZZUNITED HP SHIP - J7608 - ACETYLCYSTEINE NON-COMP UNIT","ZZZUNITED","ZZZUNITED HP SHIP","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.83,4.7699999999999996,456.36,3.31]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J0702","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - C9257","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - C9257 - PR BEVACIZUMAB INJECTION","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J2598","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,64.53,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - P9047","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,79.92,50.13,456.36,46.75]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - C9113","CORRECTIONS - CORRECTIONS BRISTOL - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - HCPCS - P9047","ZZZUNITED - ZZZUNITED HP STUDENT HEALTH - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","ZZZUNITED","ZZZUNITED HP STUDENT HEALTH","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,52.45,50.13,456.36,46.75]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3590","ZZZAETNA - ZZZAETNA POS - J3590 - PR UNCLASSIFIED BIOLOGICS","ZZZAETNA","ZZZAETNA POS","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,644.32000000000005,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J7608","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J7608 - ACETYLCYSTEINE NON-COMP UNIT","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,5.66,4.7699999999999996,456.36,3.31]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - J7307","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - J7307 - ETONOGESTREL IMPLANT SYSTEM","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1114.33,420.34,2688.55,790.75]
["ZZZUNITED - ZZZUNITED PASSPORT CONNECT - HCPCS - P9047","ZZZUNITED - ZZZUNITED PASSPORT CONNECT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","ZZZUNITED","ZZZUNITED PASSPORT CONNECT","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,52.45,50.13,456.36,46.75]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - A9576","ZZZUNITED - ZZZUNITED STANDARD - A9576 - INJ PROHANCE MULTIPACK","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - HCPCS - C9257","UNITED MEDICARE MANAGED - UNITED MCR MNG HMO - C9257 - PR BEVACIZUMAB INJECTION","UNITED MEDICARE MANAGED","UNITED MCR MNG HMO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J1250","ZZZUNITED - ZZZUNITED STANDARD - J1250 - PR INJ DOBUTAMINE HCL/250 MG","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["ZZZUNITED - ZZZUNITED STANDARD - HCPCS - J3301","ZZZUNITED - ZZZUNITED STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","ZZZUNITED","ZZZUNITED STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["BCBS - BCBS PPO - HCPCS - C9113","BCBS - BCBS PPO - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","BCBS","BCBS PPO","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - HCPCS - J7608","WORKERS COMP - ZZZWORKERS COMP ATLANTIC CHARTER INS - J7608 - ACETYLCYSTEINE NON-COMP UNIT","WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,5.66,4.7699999999999996,456.36,3.31]
["UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - HCPCS - J3590","UNITED MEDICARE MANAGED - UNITED MCR MNG PPO - J3590 - PR UNCLASSIFIED BIOLOGICS","UNITED MEDICARE MANAGED","UNITED MCR MNG PPO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J1817","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J1817 - PR INSULIN FOR INSULIN PUMP USE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["BCBS - BCBS SHIP PPO - HCPCS - C9113","BCBS - BCBS SHIP PPO - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","BCBS","BCBS SHIP PPO","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - C9257","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - C9257 - PR BEVACIZUMAB INJECTION","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,14.96,1.68,456.36,8.75]
["UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - HCPCS - J8540","UNITED MEDICARE MANAGED - UNITED SCO MCR MNG PPO - J8540 - PR ORAL DEXAMETHASONE","UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - S0020","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - S0020 - PR INJECTION, BUPIVICAINE HYDRO","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - HCPCS - J1250","UNITED MEDICARE MANAGED - ZZZUNITED SCO MCR MNG HMO - J1250 - PR INJ DOBUTAMINE HCL/250 MG","UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["UNICARE - UNICARE STANDARD - HCPCS - A9576","UNICARE - UNICARE STANDARD - A9576 - INJ PROHANCE MULTIPACK","UNICARE","UNICARE STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,1.58,1.58,456.36,1.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - HCPCS - J1817","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE HMO - J1817 - PR INSULIN FOR INSULIN PUMP USE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - J3301","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,6.41,0.98,456.36,3.75]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - C9113","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - HCPCS - J7608","UPHAMS CORNER ESP - UPHAMS CORNER ESP STANDARD - J7608 - ACETYLCYSTEINE NON-COMP UNIT","UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,5.3,4.7699999999999996,456.36,3.31]
["UNICARE - UNICARE STANDARD - HCPCS - J3590","UNICARE - UNICARE STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","UNICARE","UNICARE STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,913.5,420.34,1218,304.5]
["WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - HCPCS - P9047","WORKERS COMP - ZZZWORKERS COMP BOSTON FIRE DEPARTMENT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,79.92,50.13,456.36,46.75]
["WELLCARE - WELLCARE HMO - HCPCS - J2598","WELLCARE - WELLCARE HMO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WELLCARE","WELLCARE HMO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,37.75,36.299999999999997,456.36,37.75]
["WELLCARE - WELLCARE HMO - HCPCS - J3590","WELLCARE - WELLCARE HMO - J3590 - PR UNCLASSIFIED BIOLOGICS","WELLCARE","WELLCARE HMO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J2930","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J2930 - PR METHYLPREDNISOLONE INJECTION","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J0131","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J0131 - PR ACETAMINOPHEN INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["WELLCARE - WELLCARE PPO - HCPCS - J2598","WELLCARE - WELLCARE PPO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WELLCARE","WELLCARE PPO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,37.75,36.299999999999997,456.36,37.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3010","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J3010 - PR FENTANYL CITRATE INJECITON","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.22,0.19,456.36,0.13]
["UNITED - UNITED DEFINITY HRA - HCPCS - J3590","UNITED - UNITED DEFINITY HRA - J3590 - PR UNCLASSIFIED BIOLOGICS","UNITED","UNITED DEFINITY HRA","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1817","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J1817 - PR INSULIN FOR INSULIN PUMP USE","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - HCPCS - A9576","TUFTS MEDICARE MANAGED - TUFTS SCO MCR MNG ONECARE - A9576 - INJ PROHANCE MULTIPACK","TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["UNITED - UNITED HP SHIP - HCPCS - C9257","UNITED - UNITED HP SHIP - C9257 - PR BEVACIZUMAB INJECTION","UNITED","UNITED HP SHIP","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - HCPCS - J3590","WORKERS COMP - WORKERS COMP US DEPARTMENT OF LABOR - J3590 - PR UNCLASSIFIED BIOLOGICS","WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,520.57000000000005,420.34,1218,304.5]
["AETNA - AETNA HMO - HCPCS - C9113","AETNA - AETNA HMO - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","AETNA","AETNA HMO","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,9.4,6.4,456.36,4.4400000000000004]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - HCPCS - J7608","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE - WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD - J7608 - ACETYLCYSTEINE NON-COMP UNIT","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,4.7699999999999996,4.7699999999999996,456.36,3.31]
["UNITED - UNITED HP SHIP - HCPCS - J3301","UNITED - UNITED HP SHIP - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","UNITED","UNITED HP SHIP","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - A9576","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - A9576 - INJ PROHANCE MULTIPACK","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - HCPCS - J2598","WELLSENSE MEDICARE MANAGED - WELLSENSE MCR MNG STANDARD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["AETNA - AETNA HMO - HCPCS - J2930","AETNA - AETNA HMO - J2930 - PR METHYLPREDNISOLONE INJECTION","AETNA","AETNA HMO","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,42.46,24.44,456.36,20.07]
["TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - HCPCS - J3010","TUFTS MEDICARE MANAGED - ZZZTUFTS MCR MNG ONECARE - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["AETNA - AETNA HMO - HCPCS - S0020","AETNA - AETNA HMO - S0020 - PR INJECTION, BUPIVICAINE HYDRO","AETNA","AETNA HMO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,3.67,2.4900000000000002,456.36,1.73]
["WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - HCPCS - J8540","WELLSENSE MEDICARE MANAGED - WELLSENSE SCO/SENIOR CARE OPTIONS - J8540 - PR ORAL DEXAMETHASONE","WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - C9257","WORKERS COMP - ZZZWORKERS COMP AIG - C9257 - PR BEVACIZUMAB INJECTION","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,14.96,1.68,456.36,8.75]
["UNITED - UNITED HP STUDENT HEALTH - HCPCS - J3590","UNITED - UNITED HP STUDENT HEALTH - J3590 - PR UNCLASSIFIED BIOLOGICS","UNITED","UNITED HP STUDENT HEALTH","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,609,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - HCPCS - J7307","WORKERS COMP - WORKERS COMP AIM MUTUAL C/O CORVEL CORP - J7307 - ETONOGESTREL IMPLANT SYSTEM","WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1351.87,420.34,2688.55,790.75]
["CCA - CCA SCO ONECARE - HCPCS - J2930","CCA - CCA SCO ONECARE - J2930 - PR METHYLPREDNISOLONE INJECTION","CCA","CCA SCO ONECARE","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - HCPCS - A9576","TUFTS MEDICARE MANAGED - ZZZTUFTS SCO MCR MNG HMO - A9576 - INJ PROHANCE MULTIPACK","TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["AETNA - AETNA POS - HCPCS - C9113","AETNA - AETNA POS - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","AETNA","AETNA POS","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,9.4,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - A9576","ZZZAETNA - ZZZAETNA HMO - A9576 - INJ PROHANCE MULTIPACK","ZZZAETNA","ZZZAETNA HMO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["CCA - ZZZCCA STANDARD - HCPCS - C9113","CCA - ZZZCCA STANDARD - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","CCA","ZZZCCA STANDARD","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["UNITED - UNITED NAVIGATE - HCPCS - J3010","UNITED - UNITED NAVIGATE - J3010 - PR FENTANYL CITRATE INJECITON","UNITED","UNITED NAVIGATE","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["UNITED - UNITED NAVIGATE - HCPCS - J3301","UNITED - UNITED NAVIGATE - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","UNITED","UNITED NAVIGATE","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - C9113","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","C9113","PR INJ PANTOPRAZOLE SODIUM, VIA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",17.77,17.77,6.4,456.36,4.4400000000000004]
["ZZZAETNA - ZZZAETNA HMO - HCPCS - J3301","ZZZAETNA - ZZZAETNA HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","ZZZAETNA","ZZZAETNA HMO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.94,0.98,456.36,3.75]
["WORKERS COMP - ZZZWORKERS COMP AIG - HCPCS - J7307","WORKERS COMP - ZZZWORKERS COMP AIG - J7307 - ETONOGESTREL IMPLANT SYSTEM","WORKERS COMP","ZZZWORKERS COMP AIG","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1351.87,420.34,2688.55,790.75]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - C9257","UNITED - UNITED PASSPORT CONNECT - C9257 - PR BEVACIZUMAB INJECTION","UNITED","UNITED PASSPORT CONNECT","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.0299999999999998,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J0583","WORKERS COMP - WORKERS COMP CCMSI - J0583 - PR BIVALIRUDIN","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,113.88,55,456.36,66.61]
["WORKERS COMP - WORKERS COMP CCMSI - HCPCS - J3301","WORKERS COMP - WORKERS COMP CCMSI - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","WORKERS COMP","WORKERS COMP CCMSI","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,6.41,0.98,456.36,3.75]
["UNITED - UNITED PASSPORT CONNECT - HCPCS - J3010","UNITED - UNITED PASSPORT CONNECT - J3010 - PR FENTANYL CITRATE INJECITON","UNITED","UNITED PASSPORT CONNECT","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J0131","CCA MEDICARE PREFERRED - ZZZCCA - J0131 - PR ACETAMINOPHEN INJECTION","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.36,5.0999999999999996,456.36,10.66]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J1817","CCA MEDICARE PREFERRED - ZZZCCA - J1817 - PR INSULIN FOR INSULIN PUMP USE","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["WORKERS COMP - WORKERS COMP MBTA - HCPCS - J3301","WORKERS COMP - WORKERS COMP MBTA - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","WORKERS COMP","WORKERS COMP MBTA","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,6.41,0.98,456.36,3.75]
["AETNA - AETNA PPO EPO - HCPCS - S0020","AETNA - AETNA PPO EPO - S0020 - PR INJECTION, BUPIVICAINE HYDRO","AETNA","AETNA PPO EPO","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,3.67,2.4900000000000002,456.36,1.73]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - C9257","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - C9257 - PR BEVACIZUMAB INJECTION","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,14.96,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - HCPCS - C9257","WORKERS COMP - WORKERS COMP COMMONWEALTH OF MASS - C9257 - PR BEVACIZUMAB INJECTION","WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,14.96,1.68,456.36,8.75]
["WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - HCPCS - J0702","WORKERS COMP - ZZZWORKERS COMP AMTRUST NEW ENGLAND - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,53.85,7.07,456.36,31.5]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J1817","AETNA - AETNA STUDENT HEALTH - J1817 - PR INSULIN FOR INSULIN PUMP USE","AETNA","AETNA STUDENT HEALTH","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,35.67,24.27,456.36,16.86]
["UNITED - UNITED STANDARD - HCPCS - J8540","UNITED - UNITED STANDARD - J8540 - PR ORAL DEXAMETHASONE","UNITED","UNITED STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J0702","WORKERS COMP - WORKERS COMP COVE RISK - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,53.85,7.07,456.36,31.5]
["ZZZAETNA - ZZZAETNA MCR SUPP - HCPCS - J8540","ZZZAETNA - ZZZAETNA MCR SUPP - J8540 - PR ORAL DEXAMETHASONE","ZZZAETNA","ZZZAETNA MCR SUPP","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.11,0.09,456.36,0.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0131","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J0131 - PR ACETAMINOPHEN INJECTION","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J0131","PR ACETAMINOPHEN INJECTION","J0131 - PR ACETAMINOPHEN INJECTION",42.63,5.0999999999999996,5.0999999999999996,456.36,10.66]
["WORKERS COMP - WORKERS COMP COVE RISK - HCPCS - J8540","WORKERS COMP - WORKERS COMP COVE RISK - J8540 - PR ORAL DEXAMETHASONE","WORKERS COMP","WORKERS COMP COVE RISK","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.43,0.09,456.36,0.25]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - C9257","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - C9257 - PR BEVACIZUMAB INJECTION","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,14.96,1.68,456.36,8.75]
["ZZZAETNA - ZZZAETNA POS - HCPCS - A9576","ZZZAETNA - ZZZAETNA POS - A9576 - INJ PROHANCE MULTIPACK","ZZZAETNA","ZZZAETNA POS","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - HCPCS - J3590","UNITED COMMUNITY PLAN - UHC COMMUNITY SCO HMO - J3590 - PR UNCLASSIFIED BIOLOGICS","UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - HCPCS - J7307","WORKERS COMP - WORKERS COMP GALLAGHER BASSETT - J7307 - ETONOGESTREL IMPLANT SYSTEM","WORKERS COMP","WORKERS COMP GALLAGHER BASSETT","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1351.87,420.34,2688.55,790.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - S0020","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - S0020 - PR INJECTION, BUPIVICAINE HYDRO","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - HCPCS - J0702","TUFTS MEDICARE MANAGED - TUFTS MCR MNG POS - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - C9257","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - C9257 - PR BEVACIZUMAB INJECTION","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["ZZZAETNA - ZZZAETNA POS - HCPCS - J3301","ZZZAETNA - ZZZAETNA POS - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","ZZZAETNA","ZZZAETNA POS","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.94,0.98,456.36,3.75]
["BCBS - BCBS HMO - HCPCS - J1817","BCBS - BCBS HMO - J1817 - PR INSULIN FOR INSULIN PUMP USE","BCBS","BCBS HMO","HCPCS","J1817","PR INSULIN FOR INSULIN PUMP USE","J1817 - PR INSULIN FOR INSULIN PUMP USE",67.430000000000007,67.430000000000007,24.27,456.36,16.86]
["UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - HCPCS - J8540","UNITED COMMUNITY PLAN - ZZZUHC COMMUNITY PLAN STANDARD - J8540 - PR ORAL DEXAMETHASONE","UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J2930","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J2930 - PR METHYLPREDNISOLONE INJECTION","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J2930","PR METHYLPREDNISOLONE INJECTION","J2930 - PR METHYLPREDNISOLONE INJECTION",80.260000000000005,80.260000000000005,24.44,456.36,20.07]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - S0020","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - S0020 - PR INJECTION, BUPIVICAINE HYDRO","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","S0020","PR INJECTION, BUPIVICAINE HYDRO","S0020 - PR INJECTION, BUPIVICAINE HYDRO",6.93,6.93,2.4900000000000002,456.36,1.73]
["WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - HCPCS - J7307","WORKERS COMP - WORKERS COMP LIBERTY MUTUAL - J7307 - ETONOGESTREL IMPLANT SYSTEM","WORKERS COMP","WORKERS COMP LIBERTY MUTUAL","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1351.87,420.34,2688.55,790.75]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - C9257","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - C9257 - PR BEVACIZUMAB INJECTION","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J0702","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,53.85,7.07,456.36,31.5]
["WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - HCPCS - J3590","WORKERS COMP - WORKERS COMP MASS BAYSTATE SELF INS - J3590 - PR UNCLASSIFIED BIOLOGICS","WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,520.57000000000005,420.34,1218,304.5]
["UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - HCPCS - P9047","UNITED MEDICARE MANAGED - UNITED MA MMP ONECARE - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["UNITED - UNITED NAVIGATE - HCPCS - J8540","UNITED - UNITED NAVIGATE - J8540 - PR ORAL DEXAMETHASONE","UNITED","UNITED NAVIGATE","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["UNITED - UNITED NAVIGATE - HCPCS - Q0249","UNITED - UNITED NAVIGATE - Q0249 - TOCILIZUMAB FOR COVID-19","UNITED","UNITED NAVIGATE","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,9,3.24,456.36,2.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J8540","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J8540 - PR ORAL DEXAMETHASONE","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["TUFTS - TUFTS PPO - HCPCS - J3301","TUFTS - TUFTS PPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS","TUFTS PPO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3590","MEDICARE - MEDICARE PART A ONLY - J3590 - PR UNCLASSIFIED BIOLOGICS","MEDICARE","MEDICARE PART A ONLY","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J3301","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - HCPCS - J7608","BCBS OUT OF STATE - BCBS OUT OF STATE INDEMNITY - J7608 - ACETYLCYSTEINE NON-COMP UNIT","BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,9.36,4.7699999999999996,456.36,3.31]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J2598","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,85.04,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,420.34,3.24,456.36,2.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE POS - HCPCS - J0583","BCBS OUT OF STATE - BCBS OUT OF STATE POS - J0583 - PR BIVALIRUDIN","BCBS OUT OF STATE","BCBS OUT OF STATE POS","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["AETNA - AETNA POS - HCPCS - J3010","AETNA - AETNA POS - J3010 - PR FENTANYL CITRATE INJECITON","AETNA","AETNA POS","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.28000000000000003,0.19,456.36,0.13]
["HSN DENTAL - HSN DENTAL - HCPCS - J0702","HSN DENTAL - HSN DENTAL - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","HSN DENTAL","HSN DENTAL","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,456.36,7.07,456.36,31.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J2598","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,85.04,36.299999999999997,456.36,37.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - A9576","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - A9576 - INJ PROHANCE MULTIPACK","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["BCBS - BCBS HMO - HCPCS - J2598","BCBS - BCBS HMO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","BCBS","BCBS HMO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,37.6,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS SELECT - HCPCS - J3301","TUFTS - TUFTS SELECT - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS","TUFTS SELECT","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J7608","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J7608 - ACETYLCYSTEINE NON-COMP UNIT","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,9.36,4.7699999999999996,456.36,3.31]
["BCBS OUT OF STATE - BCBS OUT OF STATE PPO - HCPCS - J8540","BCBS OUT OF STATE - BCBS OUT OF STATE PPO - J8540 - PR ORAL DEXAMETHASONE","BCBS OUT OF STATE","BCBS OUT OF STATE PPO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["CCA - CCA SCO ONECARE - HCPCS - C9257","CCA - CCA SCO ONECARE - C9257 - PR BEVACIZUMAB INJECTION","CCA","CCA SCO ONECARE","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J2598","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,150.99,36.299999999999997,456.36,37.75]
["CCA - CCA SCO ONECARE - HCPCS - J3010","CCA - CCA SCO ONECARE - J3010 - PR FENTANYL CITRATE INJECITON","CCA","CCA SCO ONECARE","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CCA - CCA SCO ONECARE - HCPCS - J8540","CCA - CCA SCO ONECARE - J8540 - PR ORAL DEXAMETHASONE","CCA","CCA SCO ONECARE","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J7608","HSN PARTIAL - HSN PARTIAL TEMPORARY - J7608 - ACETYLCYSTEINE NON-COMP UNIT","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,456.36,4.7699999999999996,456.36,3.31]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - P9047","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - C9257","MEDICARE - MEDICARE PART A ONLY - C9257 - PR BEVACIZUMAB INJECTION","MEDICARE","MEDICARE PART A ONLY","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["CCA - CCA SCO STANDARD - HCPCS - P9047","CCA - CCA SCO STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CCA","CCA SCO STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - HCPCS - J1250","SENIOR WHOLE HEALTH - ZZZSENIOR WHOLE HEALTH STANDARD - J1250 - PR INJ DOBUTAMINE HCL/250 MG","SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["TUFTS - TUFTS HMO - HCPCS - A9576","TUFTS - TUFTS HMO - A9576 - INJ PROHANCE MULTIPACK","TUFTS","TUFTS HMO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["CCA - ZZZCCA STANDARD - HCPCS - J3301","CCA - ZZZCCA STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CCA","ZZZCCA STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["CCA - ZZZCCA STANDARD - HCPCS - J8540","CCA - ZZZCCA STANDARD - J8540 - PR ORAL DEXAMETHASONE","CCA","ZZZCCA STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,50.26,36.299999999999997,456.36,37.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J0702","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J3010","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J3010 - PR FENTANYL CITRATE INJECITON","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - HCPCS - J3590","CCA MEDICARE PREFERRED - CCA MEDICARE PREFERRED PPO - J3590 - PR UNCLASSIFIED BIOLOGICS","CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J7608","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J7608 - ACETYLCYSTEINE NON-COMP UNIT","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.83,4.7699999999999996,456.36,3.31]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - P9047","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,52.45,50.13,456.36,46.75]
["CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - HCPCS - J3301","CCA MEDICARE PREFERRED - CCA MEDICARE VALUE PPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - A9576","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - A9576 - INJ PROHANCE MULTIPACK","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - J7608","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - J7608 - ACETYLCYSTEINE NON-COMP UNIT","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.83,4.7699999999999996,456.36,3.31]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J0702","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CCA MEDICARE PREFERRED - ZZZCCA - HCPCS - J3010","CCA MEDICARE PREFERRED - ZZZCCA - J3010 - PR FENTANYL CITRATE INJECITON","CCA MEDICARE PREFERRED","ZZZCCA","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["HSN - HSN TEMPORARY - HCPCS - J3010","HSN - HSN TEMPORARY - J3010 - PR FENTANYL CITRATE INJECITON","HSN","HSN TEMPORARY","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,456.36,0.19,456.36,0.13]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J3010","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J3010 - PR FENTANYL CITRATE INJECITON","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,456.36,0.19,456.36,0.13]
["CIGNA - CIGNA CARELINK - HCPCS - J0702","CIGNA - CIGNA CARELINK - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CIGNA","CIGNA CARELINK","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CIGNA - CIGNA CARELINK - HCPCS - J3301","CIGNA - CIGNA CARELINK - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CIGNA","CIGNA CARELINK","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["CIGNA - CIGNA CARELINK - HCPCS - J3590","CIGNA - CIGNA CARELINK - J3590 - PR UNCLASSIFIED BIOLOGICS","CIGNA","CIGNA CARELINK","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J7307","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J7307 - ETONOGESTREL IMPLANT SYSTEM","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1781.4,420.34,2688.55,790.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J1250","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J1250 - PR INJ DOBUTAMINE HCL/250 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["CIGNA - CIGNA LOCALPLUS - HCPCS - J1250","CIGNA - CIGNA LOCALPLUS - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CIGNA","CIGNA LOCALPLUS","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,7.65,3.24,456.36,2.25]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J2598","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - C9257","OXFORD HEALTH - OXFORD HEALTH STANDARD - C9257 - PR BEVACIZUMAB INJECTION","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["CIGNA - CIGNA LOCALPLUS - HCPCS - Q0249","CIGNA - CIGNA LOCALPLUS - Q0249 - TOCILIZUMAB FOR COVID-19","CIGNA","CIGNA LOCALPLUS","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,7.65,3.24,456.36,2.25]
["CIGNA - CIGNA STANDARD - HCPCS - J0583","CIGNA - CIGNA STANDARD - J0583 - PR BIVALIRUDIN","CIGNA","CIGNA STANDARD","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,226.47,55,456.36,66.61]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J3590","TRICARE FOR LIFE - TRICARE FOR LIFE - J3590 - PR UNCLASSIFIED BIOLOGICS","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CIGNA - CIGNA STANDARD - HCPCS - J3301","CIGNA - CIGNA STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CIGNA","CIGNA STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,12.75,0.98,456.36,3.75]
["CIGNA - CIGNA STANDARD - HCPCS - J3590","CIGNA - CIGNA STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","CIGNA","CIGNA STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1035.3,420.34,1218,304.5]
["CIGNA - CIGNA STANDARD - HCPCS - J8540","CIGNA - CIGNA STANDARD - J8540 - PR ORAL DEXAMETHASONE","CIGNA","CIGNA STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.85,0.09,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J3301","AETNA - AETNA STUDENT HEALTH - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA STUDENT HEALTH","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.94,0.98,456.36,3.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J7307","AETNA - AETNA STUDENT HEALTH - J7307 - ETONOGESTREL IMPLANT SYSTEM","AETNA","AETNA STUDENT HEALTH","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1673.23,420.34,2688.55,790.75]
["CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - HCPCS - J3301","CORRECTIONS - CORRECTIONS BARNSTABLE COUNTY - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["BCBS - BCBS HMO - HCPCS - J0702","BCBS - BCBS HMO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","BCBS","BCBS HMO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J2598","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,37.6,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS BRISTOL - HCPCS - J2598","CORRECTIONS - CORRECTIONS BRISTOL - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","CORRECTIONS BRISTOL","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - HCPCS - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE PPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["BCBS - BCBS STANDARD - HCPCS - J8540","BCBS - BCBS STANDARD - J8540 - PR ORAL DEXAMETHASONE","BCBS","BCBS STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["BCBS - BCBS INDEMNITY - HCPCS - J0702","BCBS - BCBS INDEMNITY - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","BCBS","BCBS INDEMNITY","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - J3010","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - HCPCS - P9047","CORRECTIONS - CORRECTIONS BRISTOL-N DARTZZZ - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J7608","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J7608 - ACETYLCYSTEINE NON-COMP UNIT","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.83,4.7699999999999996,456.36,3.31]
["CORRECTIONS - CORRECTIONS DEVENS PROGRAM - HCPCS - J1250","CORRECTIONS - CORRECTIONS DEVENS PROGRAM - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","CORRECTIONS DEVENS PROGRAM","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J3590","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J3590 - PR UNCLASSIFIED BIOLOGICS","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,609,420.34,1218,304.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - HCPCS - J2598","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE SHIP - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,150.99,36.299999999999997,456.36,37.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0583","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J0583 - PR BIVALIRUDIN","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - HCPCS - J0702","CORRECTIONS - CORRECTIONS DPT OF YOUTH SVC - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J8540","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J8540 - PR ORAL DEXAMETHASONE","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - C9257","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - C9257 - PR BEVACIZUMAB INJECTION","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.0299999999999998,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - C9257","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - C9257 - PR BEVACIZUMAB INJECTION","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J1250","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS ESSEX SALISBURY - HCPCS - J3010","CORRECTIONS - CORRECTIONS ESSEX SALISBURY - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","CORRECTIONS ESSEX SALISBURY","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["HSN - HSN TEMPORARY - HCPCS - C9257","HSN - HSN TEMPORARY - C9257 - PR BEVACIZUMAB INJECTION","HSN","HSN TEMPORARY","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,456.36,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - A9576","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - A9576 - INJ PROHANCE MULTIPACK","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J0702","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - HCPCS - J2598","CORRECTIONS - CORRECTIONS HAMPDEN COUNTY - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","CORRECTIONS HAMPDEN COUNTY","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["HSN DENTAL - HSN DENTAL - HCPCS - P9047","HSN DENTAL - HSN DENTAL - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","HSN DENTAL","HSN DENTAL","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,456.36,50.13,456.36,46.75]
["BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - HCPCS - Q0249","BCBS - BLUE BENEFITS ADMINISTRATORS OF MA - Q0249 - TOCILIZUMAB FOR COVID-19","BCBS","BLUE BENEFITS ADMINISTRATORS OF MA","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,5.81,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - HCPCS - J1250","CORRECTIONS - CORRECTIONS HEALTHCOST SOLUTIONS - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - P9047","HSN PARTIAL - HSN PARTIAL TEMPORARY - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,456.36,50.13,456.36,46.75]
["HUMANA MEDICARE - HUMANA MEDICARE STANDARD - HCPCS - J3590","HUMANA MEDICARE - HUMANA MEDICARE STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","HUMANA MEDICARE","HUMANA MEDICARE STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - HCPCS - J3301","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIG COMMERCIAL EPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,8.4499999999999993,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J0702","CORRECTIONS - CORRECTIONS ICE INMATE - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J1250","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J1250 - PR INJ DOBUTAMINE HCL/250 MG","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,5.07,3.24,456.36,2.25]
["CORRECTIONS - CORRECTIONS ICE INMATE - HCPCS - J3590","CORRECTIONS - CORRECTIONS ICE INMATE - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","CORRECTIONS ICE INMATE","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - A9576","CORRECTIONS - CORRECTIONS MIDDLESEX - A9576 - INJ PROHANCE MULTIPACK","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["CORRECTIONS - CORRECTIONS MIDDLESEX - HCPCS - J0583","CORRECTIONS - CORRECTIONS MIDDLESEX - J0583 - PR BIVALIRUDIN","CORRECTIONS","CORRECTIONS MIDDLESEX","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J3010","MEDICARE - MEDICARE PART A ONLY - J3010 - PR FENTANYL CITRATE INJECITON","MEDICARE","MEDICARE PART A ONLY","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - HCPCS - J3590","BCBS MEDICARE MANAGED - BCBS MCR MNG HMO - J3590 - PR UNCLASSIFIED BIOLOGICS","BCBS MEDICARE MANAGED","BCBS MCR MNG HMO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - CORRECTIONS NAPHCARE - HCPCS - C9257","CORRECTIONS - CORRECTIONS NAPHCARE - C9257 - PR BEVACIZUMAB INJECTION","CORRECTIONS","CORRECTIONS NAPHCARE","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - J3301","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - P9047","OXFORD HEALTH - OXFORD HEALTH STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,138.30000000000001,50.13,456.36,46.75]
["BCBS - BCBS HMO - HCPCS - C9257","BCBS - BCBS HMO - C9257 - PR BEVACIZUMAB INJECTION","BCBS","BCBS HMO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.27,1.68,456.36,8.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J1250","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J1250 - PR INJ DOBUTAMINE HCL/250 MG","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["BCBS - BCBS INDEMNITY - HCPCS - J8540","BCBS - BCBS INDEMNITY - J8540 - PR ORAL DEXAMETHASONE","BCBS","BCBS INDEMNITY","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J0583","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J0583 - PR BIVALIRUDIN","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["CORRECTIONS - CORRECTIONS NASHUA - HCPCS - P9047","CORRECTIONS - CORRECTIONS NASHUA - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","CORRECTIONS NASHUA","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - C9257","CORRECTIONS - CORRECTIONS NORFOLK - C9257 - PR BEVACIZUMAB INJECTION","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["CORRECTIONS - CORRECTIONS NORFOLK - HCPCS - J0583","CORRECTIONS - CORRECTIONS NORFOLK - J0583 - PR BIVALIRUDIN","CORRECTIONS","CORRECTIONS NORFOLK","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS HMO - HCPCS - J2598","TUFTS - TUFTS HMO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS","TUFTS HMO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,150.99,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS POS - HCPCS - J7307","TUFTS - TUFTS POS - J7307 - ETONOGESTREL IMPLANT SYSTEM","TUFTS","TUFTS POS","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1119.79,420.34,2688.55,790.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - HCPCS - J2598","AARP UHC MEDICARE COMPLETE - AARP UHC MEDICARE COMPLETE STANDARD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS SELECT - HCPCS - J0583","TUFTS - TUFTS SELECT - J0583 - PR BIVALIRUDIN","TUFTS","TUFTS SELECT","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS SELECT - HCPCS - J2598","TUFTS - TUFTS SELECT - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS","TUFTS SELECT","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,150.99,36.299999999999997,456.36,37.75]
["BCBS - BCBS POS - HCPCS - J3301","BCBS - BCBS POS - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","BCBS","BCBS POS","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - C9257","CORRECTIONS - CORRECTIONS PLYMOUTH - C9257 - PR BEVACIZUMAB INJECTION","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3590","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,420.34,420.34,1218,304.5]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - J3010","CORRECTIONS - CORRECTIONS PLYMOUTH - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - CORRECTIONS PLYMOUTH - HCPCS - P9047","CORRECTIONS - CORRECTIONS PLYMOUTH - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","CORRECTIONS PLYMOUTH","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["BCBS - BCBS POS - HCPCS - J8540","BCBS - BCBS POS - J8540 - PR ORAL DEXAMETHASONE","BCBS","BCBS POS","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,420.34,0.09,456.36,0.25]
["AETNA - AETNA STUDENT HEALTH - HCPCS - P9047","AETNA - AETNA STUDENT HEALTH - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA","AETNA STUDENT HEALTH","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,98.92,50.13,456.36,46.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J3590","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3010","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J7307","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J7307 - ETONOGESTREL IMPLANT SYSTEM","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,420.34,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - HCPCS - P9047","CORRECTIONS - CORRECTIONS SUFFOLK COUNTY - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","CORRECTIONS SUFFOLK COUNTY","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,58.38,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - P9047","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,420.34,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,420.34,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J3010","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS BAY STATE - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS BAY STATE - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS BAY STATE","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - A9576","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - A9576 - INJ PROHANCE MULTIPACK","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["FALLON SCO - FALLON SCO HMO - HCPCS - J8540","FALLON SCO - FALLON SCO HMO - J8540 - PR ORAL DEXAMETHASONE","FALLON SCO","FALLON SCO HMO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - J2598","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - HCPCS - P9047","CORRECTIONS - ZZZCORRECTIONS BOSTON PRE-REL - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - HCPCS - J8540","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE CHOICE PLUS - J8540 - PR ORAL DEXAMETHASONE","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["BCBS - BCBS STANDARD - HCPCS - Q0249","BCBS - BCBS STANDARD - Q0249 - TOCILIZUMAB FOR COVID-19","BCBS","BCBS STANDARD","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,5.81,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS BRADSTON - HCPCS - J3010","CORRECTIONS - ZZZCORRECTIONS BRADSTON - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","ZZZCORRECTIONS BRADSTON","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - C9257","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - C9257 - PR BEVACIZUMAB INJECTION","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.0299999999999998,1.68,456.36,8.75]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - J8540","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - J8540 - PR ORAL DEXAMETHASONE","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - HCPCS - Q0249","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE INDEMNITY - Q0249 - TOCILIZUMAB FOR COVID-19","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,6.77,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J2598","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS BRIDGEWATER ST - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - HCPCS - J0702","HARVARD PILGRIM HEALTH CARE - HARVARD PILGRIM HEALTH CARE PPO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J0583","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J0583 - PR BIVALIRUDIN","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3010","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - HCPCS - J3301","CORRECTIONS - ZZZCORRECTIONS BRISTOL-NEW BED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J0702","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - HCPCS - J8540","HEALTH PLANS INC - HEALTH PLANS INC BMC PPO - J8540 - PR ORAL DEXAMETHASONE","HEALTH PLANS INC","HEALTH PLANS INC BMC PPO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS CEDAR - HCPCS - J2598","CORRECTIONS - ZZZCORRECTIONS CEDAR - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","ZZZCORRECTIONS CEDAR","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J8540","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J8540 - PR ORAL DEXAMETHASONE","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - HCPCS - J7608","HEALTH PLANS INC - HEALTH PLANS INC BMC SELECT - J7608 - ACETYLCYSTEINE NON-COMP UNIT","HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.83,4.7699999999999996,456.36,3.31]
["HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - HCPCS - C9257","HEALTH PLANS INC - HEALTH PLANS INC BMC TIERED HMO - C9257 - PR BEVACIZUMAB INJECTION","HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.0299999999999998,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - J3010","CORRECTIONS - ZZZCORRECTIONS CONCORD - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS CONCORD - HCPCS - P9047","CORRECTIONS - ZZZCORRECTIONS CONCORD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZCORRECTIONS CONCORD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["HEALTH PLANS INC - HEALTH PLANS INC STANDARD - HCPCS - J7608","HEALTH PLANS INC - HEALTH PLANS INC STANDARD - J7608 - ACETYLCYSTEINE NON-COMP UNIT","HEALTH PLANS INC","HEALTH PLANS INC STANDARD","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.83,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - HCPCS - J1250","CORRECTIONS - ZZZCORRECTIONS ESSEX MIDDLETON - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - HCPCS - J3590","HPHC MEDICARE MANAGED - HARVARD PILGRIM MEDICARE ADV STRIDE - J3590 - PR UNCLASSIFIED BIOLOGICS","HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["HSN - HSN STANDARD - HCPCS - A9576","HSN - HSN STANDARD - A9576 - INJ PROHANCE MULTIPACK","HSN","HSN STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,456.36,1.58,456.36,1.25]
["HSN - HSN STANDARD - HCPCS - J3301","HSN - HSN STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","HSN","HSN STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,456.36,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS GARDNER - HCPCS - J0702","CORRECTIONS - ZZZCORRECTIONS GARDNER - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","ZZZCORRECTIONS GARDNER","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["HSN - HSN TEMPORARY - HCPCS - J1250","HSN - HSN TEMPORARY - J1250 - PR INJ DOBUTAMINE HCL/250 MG","HSN","HSN TEMPORARY","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,456.36,3.24,456.36,2.25]
["HSN - HSN TEMPORARY - HCPCS - J3301","HSN - HSN TEMPORARY - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","HSN","HSN TEMPORARY","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,456.36,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - C9257","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - C9257 - PR BEVACIZUMAB INJECTION","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J1250","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - HCPCS - J3010","CORRECTIONS - ZZZCORRECTIONS LEMUEL SHATTUCK - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["HSN CONFIDENTIAL - HSN CONFIDENTIAL - HCPCS - J1250","HSN CONFIDENTIAL - HSN CONFIDENTIAL - J1250 - PR INJ DOBUTAMINE HCL/250 MG","HSN CONFIDENTIAL","HSN CONFIDENTIAL","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,456.36,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - A9576","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - A9576 - INJ PROHANCE MULTIPACK","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J0702","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - HCPCS - J2598","CORRECTIONS - ZZZCORRECTIONS MASS ALCOHOL - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["HSN DENTAL - HSN DENTAL - HCPCS - J8540","HSN DENTAL - HSN DENTAL - J8540 - PR ORAL DEXAMETHASONE","HSN DENTAL","HSN DENTAL","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,456.36,0.09,456.36,0.25]
["AETNA - AETNA HMO - HCPCS - J3301","AETNA - AETNA HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA HMO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.94,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - HCPCS - J1250","CORRECTIONS - ZZZCORRECTIONS MASS TREAT CTR - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J0583","HSN PARTIAL - HSN PARTIAL TEMPORARY - J0583 - PR BIVALIRUDIN","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,456.36,55,456.36,66.61]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - J3301","HSN PARTIAL - HSN PARTIAL TEMPORARY - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,456.36,0.98,456.36,3.75]
["HSN PARTIAL - HSN PARTIAL TEMPORARY - HCPCS - Q0249","HSN PARTIAL - HSN PARTIAL TEMPORARY - Q0249 - TOCILIZUMAB FOR COVID-19","HSN PARTIAL","HSN PARTIAL TEMPORARY","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,456.36,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J0702","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["AETNA - AETNA PPO EPO - HCPCS - C9257","AETNA - AETNA PPO EPO - C9257 - PR BEVACIZUMAB INJECTION","AETNA","AETNA PPO EPO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,18.52,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX BILL - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["AETNA - AETNA HMO - HCPCS - J7307","AETNA - AETNA HMO - J7307 - ETONOGESTREL IMPLANT SYSTEM","AETNA","AETNA HMO","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1673.23,420.34,2688.55,790.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J0583","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J0583 - PR BIVALIRUDIN","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - HCPCS - J3010","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMECIAL HMO - J3010 - PR FENTANYL CITRATE INJECITON","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.28999999999999998,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - J3301","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - HCPCS - P9047","CORRECTIONS - ZZZCORRECTIONS MIDDLESEX CAMB - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - HCPCS - J7608","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL - MASS GENERAL BRIGHAM COMMERCIAL PPO - J7608 - ACETYLCYSTEINE NON-COMP UNIT","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,7.46,4.7699999999999996,456.36,3.31]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J0702","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,70.959999999999994,7.07,456.36,31.5]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - HCPCS - J3010","MASS GENERAL BRIGHAM HEALTH PLAN PRIME - MASS GEN BRIG HLTHPLAN PPO - J3010 - PR FENTANYL CITRATE INJECITON","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.28999999999999998,0.19,456.36,0.13]
["AETNA - AETNA HMO - HCPCS - J8540","AETNA - AETNA HMO - J8540 - PR ORAL DEXAMETHASONE","AETNA","AETNA HMO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.11,0.09,456.36,0.25]
["MEDICARE - MEDICARE A&B - HCPCS - J0702","MEDICARE - MEDICARE A&B - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","MEDICARE","MEDICARE A&B","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["MEDICARE - MEDICARE A&B - HCPCS - P9047","MEDICARE - MEDICARE A&B - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","MEDICARE","MEDICARE A&B","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["MEDICARE - MEDICARE PART A ONLY - HCPCS - J0583","MEDICARE - MEDICARE PART A ONLY - J0583 - PR BIVALIRUDIN","MEDICARE","MEDICARE PART A ONLY","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS NASHUA - HCPCS - P9047","CORRECTIONS - ZZZCORRECTIONS NASHUA - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZCORRECTIONS NASHUA","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J1250","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["MEDICARE - RAILROAD MEDICARE  RAILROAD - HCPCS - A9576","MEDICARE - RAILROAD MEDICARE  RAILROAD - A9576 - INJ PROHANCE MULTIPACK","MEDICARE","RAILROAD MEDICARE  RAILROAD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS NORFOLK - HCPCS - J3301","CORRECTIONS - ZZZCORRECTIONS NORFOLK - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZCORRECTIONS NORFOLK","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["AETNA - AETNA HMO - HCPCS - Q0249","AETNA - AETNA HMO - Q0249 - TOCILIZUMAB FOR COVID-19","AETNA","AETNA HMO","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,4.76,3.24,456.36,2.25]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - C9257","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - C9257 - PR BEVACIZUMAB INJECTION","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - HCPCS - P9047","NEIGHBORHOOD PACE - NEIGHBORHOOD PACE STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS NORTHEAST CORR - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["OXFORD HEALTH - OXFORD HEALTH STANDARD - HCPCS - J3301","OXFORD HEALTH - OXFORD HEALTH STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","OXFORD HEALTH","OXFORD HEALTH STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - HCPCS - J0583","OXFORD HEALTH - ZZZOXFORD HEALTH STANDARD - J0583 - PR BIVALIRUDIN","OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3010","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS OLD COLONY - HCPCS - J3301","CORRECTIONS - ZZZCORRECTIONS OLD COLONY - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZCORRECTIONS OLD COLONY","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - A9576","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - A9576 - INJ PROHANCE MULTIPACK","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - C9257","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - C9257 - PR BEVACIZUMAB INJECTION","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J2598","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS PLYMOUTH - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS PLYMOUTH","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3301","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - C9257","TRICARE EAST - TRICARE EAST SELECT - C9257 - PR BEVACIZUMAB INJECTION","TRICARE EAST","TRICARE EAST SELECT","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.68,1.68,456.36,8.75]
["TRICARE EAST - TRICARE EAST SELECT - HCPCS - P9047","TRICARE EAST - TRICARE EAST SELECT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TRICARE EAST","TRICARE EAST SELECT","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,50.13,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J3301","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["TRICARE FOR LIFE - TRICARE FOR LIFE - HCPCS - J8540","TRICARE FOR LIFE - TRICARE FOR LIFE - J8540 - PR ORAL DEXAMETHASONE","TRICARE FOR LIFE","TRICARE FOR LIFE","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["BCBS - BCBS HMO - HCPCS - J0583","BCBS - BCBS HMO - J0583 - PR BIVALIRUDIN","BCBS","BCBS HMO","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS CARELINK - HCPCS - J3590","TUFTS - TUFTS CARELINK - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS","TUFTS CARELINK","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS S MIDDLESEX CORR - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - A9576","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - A9576 - INJ PROHANCE MULTIPACK","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["TUFTS - TUFTS HMO - HCPCS - J7608","TUFTS - TUFTS HMO - J7608 - ACETYLCYSTEINE NON-COMP UNIT","TUFTS","TUFTS HMO","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,7.57,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J2598","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS POS - HCPCS - J3010","TUFTS - TUFTS POS - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS","TUFTS POS","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3301","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["TUFTS - TUFTS POS - HCPCS - J3590","TUFTS - TUFTS POS - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS","TUFTS POS","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["TUFTS - TUFTS POS - HCPCS - J7608","TUFTS - TUFTS POS - J7608 - ACETYLCYSTEINE NON-COMP UNIT","TUFTS","TUFTS POS","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,7.57,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - J8540","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - J8540 - PR ORAL DEXAMETHASONE","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["TUFTS - TUFTS POS - HCPCS - P9047","TUFTS - TUFTS POS - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS","TUFTS POS","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.76,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS SHIRLEY - HCPCS - P9047","CORRECTIONS - ZZZCORRECTIONS SHIRLEY - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZCORRECTIONS SHIRLEY","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J1250","AETNA - AETNA STUDENT HEALTH - J1250 - PR INJ DOBUTAMINE HCL/250 MG","AETNA","AETNA STUDENT HEALTH","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.76,3.24,456.36,2.25]
["AETNA - AETNA MCR SUPP - HCPCS - J1250","AETNA - AETNA MCR SUPP - J1250 - PR INJ DOBUTAMINE HCL/250 MG","AETNA","AETNA MCR SUPP","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.76,3.24,456.36,2.25]
["TUFTS - TUFTS PPO - HCPCS - C9257","TUFTS - TUFTS PPO - C9257 - PR BEVACIZUMAB INJECTION","TUFTS","TUFTS PPO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,13.1,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - A9576","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - A9576 - INJ PROHANCE MULTIPACK","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["TUFTS - TUFTS PPO - HCPCS - J0702","TUFTS - TUFTS PPO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS","TUFTS PPO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - C9257","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - C9257 - PR BEVACIZUMAB INJECTION","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3301","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J0583","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J0583 - PR BIVALIRUDIN","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS PPO - HCPCS - J3010","TUFTS - TUFTS PPO - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS","TUFTS PPO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J0702","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["TUFTS - TUFTS PPO - HCPCS - J3590","TUFTS - TUFTS PPO - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS","TUFTS PPO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J1250","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["TUFTS - TUFTS PPO - HCPCS - J7608","TUFTS - TUFTS PPO - J7608 - ACETYLCYSTEINE NON-COMP UNIT","TUFTS","TUFTS PPO","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,8.06,4.7699999999999996,456.36,3.31]
["BCBS - BCBS STANDARD - HCPCS - J0583","BCBS - BCBS STANDARD - J0583 - PR BIVALIRUDIN","BCBS","BCBS STANDARD","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS PPO - HCPCS - P9047","TUFTS - TUFTS PPO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS","TUFTS PPO","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,57.24,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J2598","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J3590","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J3590 - PR UNCLASSIFIED BIOLOGICS","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3010","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["TUFTS - TUFTS SELECT - HCPCS - C9257","TUFTS - TUFTS SELECT - C9257 - PR BEVACIZUMAB INJECTION","TUFTS","TUFTS SELECT","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,12,1.68,456.36,8.75]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3301","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["TUFTS - TUFTS SELECT - HCPCS - J0702","TUFTS - TUFTS SELECT - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS","TUFTS SELECT","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J3590","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - J8540","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - J8540 - PR ORAL DEXAMETHASONE","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - J8540","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - J8540 - PR ORAL DEXAMETHASONE","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["TUFTS - TUFTS SELECT - HCPCS - J3010","TUFTS - TUFTS SELECT - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS","TUFTS SELECT","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - HCPCS - P9047","CORRECTIONS - ZZZCORRECTIONS SOUZA BARANOWSKI - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["TUFTS - TUFTS SELECT - HCPCS - J3590","TUFTS - TUFTS SELECT - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS","TUFTS SELECT","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["BCBS - BCBS STANDARD - HCPCS - J0702","BCBS - BCBS STANDARD - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","BCBS","BCBS STANDARD","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["TUFTS - TUFTS SELECT - HCPCS - J7608","TUFTS - TUFTS SELECT - J7608 - ACETYLCYSTEINE NON-COMP UNIT","TUFTS","TUFTS SELECT","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,7.39,4.7699999999999996,456.36,3.31]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - A9576","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - A9576 - INJ PROHANCE MULTIPACK","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["TUFTS - TUFTS SELECT - HCPCS - P9047","TUFTS - TUFTS SELECT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS","TUFTS SELECT","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,52.45,50.13,456.36,46.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - C9257","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - C9257 - PR BEVACIZUMAB INJECTION","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.94,1.68,456.36,8.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J2598","AETNA - AETNA STUDENT HEALTH - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","AETNA","AETNA STUDENT HEALTH","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,79.87,36.299999999999997,456.36,37.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J0583","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J0583 - PR BIVALIRUDIN","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS - TUFTS SPIRIT - HCPCS - C9257","TUFTS - TUFTS SPIRIT - C9257 - PR BEVACIZUMAB INJECTION","TUFTS","TUFTS SPIRIT","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J0702","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["TUFTS - TUFTS SPIRIT - HCPCS - J0702","TUFTS - TUFTS SPIRIT - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS","TUFTS SPIRIT","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J1250","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J1250 - PR INJ DOBUTAMINE HCL/250 MG","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - HCPCS - P9047","BCBS MEDICARE MANAGED - BCBS MCR MNG PPO - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","BCBS MEDICARE MANAGED","BCBS MCR MNG PPO","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["BCBS - BCBS STANDARD - HCPCS - J1250","BCBS - BCBS STANDARD - J1250 - PR INJ DOBUTAMINE HCL/250 MG","BCBS","BCBS STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,5.81,3.24,456.36,2.25]
["TUFTS - TUFTS SPIRIT - HCPCS - J3010","TUFTS - TUFTS SPIRIT - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS","TUFTS SPIRIT","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J2598","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,38.119999999999997,36.299999999999997,456.36,37.75]
["TUFTS - TUFTS SPIRIT - HCPCS - J3590","TUFTS - TUFTS SPIRIT - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS","TUFTS SPIRIT","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3010","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J3010 - PR FENTANYL CITRATE INJECITON","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["TUFTS - TUFTS SPIRIT - HCPCS - P9047","TUFTS - TUFTS SPIRIT - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS","TUFTS SPIRIT","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3301","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,420.34,1.58,456.36,1.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J3590","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J3590 - PR UNCLASSIFIED BIOLOGICS","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,420.34,55,456.36,66.61]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - J8540","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - J8540 - PR ORAL DEXAMETHASONE","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,420.34,3.24,456.36,2.25]
["CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - HCPCS - P9047","CORRECTIONS - ZZZORRECTIONS FRAMINGHAM - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZORRECTIONS FRAMINGHAM","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,420.34,36.299999999999997,456.36,37.75]
["AETNA - AETNA MCR SUPP - HCPCS - J2598","AETNA - AETNA MCR SUPP - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","AETNA","AETNA MCR SUPP","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,79.87,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,420.34,0.98,456.36,3.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - A9576","FALLON - FALLON COMMUNITY PLAN - A9576 - INJ PROHANCE MULTIPACK","FALLON","FALLON COMMUNITY PLAN","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J7307","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J7307 - ETONOGESTREL IMPLANT SYSTEM","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - C9257","FALLON - FALLON COMMUNITY PLAN - C9257 - PR BEVACIZUMAB INJECTION","FALLON","FALLON COMMUNITY PLAN","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,420.34,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0583","FALLON - FALLON COMMUNITY PLAN - J0583 - PR BIVALIRUDIN","FALLON","FALLON COMMUNITY PLAN","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - HCPCS - Q0249","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 1 - Q0249 - TOCILIZUMAB FOR COVID-19","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J0702","FALLON - FALLON COMMUNITY PLAN - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","FALLON","FALLON COMMUNITY PLAN","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,420.34,1.58,456.36,1.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J1250","FALLON - FALLON COMMUNITY PLAN - J1250 - PR INJ DOBUTAMINE HCL/250 MG","FALLON","FALLON COMMUNITY PLAN","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,420.34,55,456.36,66.61]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - P9047","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J2598","FALLON - FALLON COMMUNITY PLAN - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","FALLON","FALLON COMMUNITY PLAN","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3010","FALLON - FALLON COMMUNITY PLAN - J3010 - PR FENTANYL CITRATE INJECITON","FALLON","FALLON COMMUNITY PLAN","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,420.34,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,420.34,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J7307","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J7307 - ETONOGESTREL IMPLANT SYSTEM","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,420.34,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,420.34,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,420.34,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,420.34,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - HCPCS - Q0249","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHP CONCRE TYP 3 - Q0249 - TOCILIZUMAB FOR COVID-19","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,420.34,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J7307","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J7307 - ETONOGESTREL IMPLANT SYSTEM","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,420.34,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,420.34,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,420.34,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,420.34,55,456.36,66.61]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J1250","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J1250 - PR INJ DOBUTAMINE HCL/250 MG","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,420.34,3.24,456.36,2.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - Q0249","FALLON - FALLON COMMUNITY PLAN - Q0249 - TOCILIZUMAB FOR COVID-19","FALLON","FALLON COMMUNITY PLAN","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,420.34,36.299999999999997,456.36,37.75]
["AETNA - AETNA MCR SUPP - HCPCS - J3010","AETNA - AETNA MCR SUPP - J3010 - PR FENTANYL CITRATE INJECITON","AETNA","AETNA MCR SUPP","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.28000000000000003,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,420.34,0.98,456.36,3.75]
["FALLON - FALLON HMO STANDARD - HCPCS - A9576","FALLON - FALLON HMO STANDARD - A9576 - INJ PROHANCE MULTIPACK","FALLON","FALLON HMO STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J7307","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J7307 - ETONOGESTREL IMPLANT SYSTEM","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON HMO STANDARD - HCPCS - C9257","FALLON - FALLON HMO STANDARD - C9257 - PR BEVACIZUMAB INJECTION","FALLON","FALLON HMO STANDARD","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,420.34,0.09,456.36,0.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J0583","FALLON - FALLON HMO STANDARD - J0583 - PR BIVALIRUDIN","FALLON","FALLON HMO STANDARD","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - HCPCS - Q0249","TUFTS CONNCARE/QHP - TUFTS CONNCARE QHPCONCRE TYP 2 - Q0249 - TOCILIZUMAB FOR COVID-19","TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,420.34,3.24,456.36,2.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J0702","FALLON - FALLON HMO STANDARD - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","FALLON","FALLON HMO STANDARD","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J1250","FALLON - FALLON HMO STANDARD - J1250 - PR INJ DOBUTAMINE HCL/250 MG","FALLON","FALLON HMO STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["BCBS - BCBS STANDARD - HCPCS - J2598","BCBS - BCBS STANDARD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","BCBS","BCBS STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,37.6,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J2598","FALLON - FALLON HMO STANDARD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","FALLON","FALLON HMO STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J3010","FALLON - FALLON HMO STANDARD - J3010 - PR FENTANYL CITRATE INJECITON","FALLON","FALLON HMO STANDARD","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J3301","FALLON - FALLON HMO STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","FALLON","FALLON HMO STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE NON SUBSIDIZED - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["FALLON - FALLON HMO STANDARD - HCPCS - J3590","FALLON - FALLON HMO STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","FALLON","FALLON HMO STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,609,420.34,1218,304.5]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J7608","AETNA - AETNA STUDENT HEALTH - J7608 - ACETYLCYSTEINE NON-COMP UNIT","AETNA","AETNA STUDENT HEALTH","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,7,4.7699999999999996,456.36,3.31]
["FALLON - FALLON HMO STANDARD - HCPCS - J7307","FALLON - FALLON HMO STANDARD - J7307 - ETONOGESTREL IMPLANT SYSTEM","FALLON","FALLON HMO STANDARD","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - C9257","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - C9257 - PR BEVACIZUMAB INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,420.34,1.68,456.36,8.75]
["FALLON - FALLON HMO STANDARD - HCPCS - J7608","FALLON - FALLON HMO STANDARD - J7608 - ACETYLCYSTEINE NON-COMP UNIT","FALLON","FALLON HMO STANDARD","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J0702","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,420.34,7.07,456.36,31.5]
["FALLON - FALLON HMO STANDARD - HCPCS - J8540","FALLON - FALLON HMO STANDARD - J8540 - PR ORAL DEXAMETHASONE","FALLON","FALLON HMO STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.5,0.09,456.36,0.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J0702","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["FALLON - FALLON HMO STANDARD - HCPCS - P9047","FALLON - FALLON HMO STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","FALLON","FALLON HMO STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3010","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON HMO STANDARD - HCPCS - Q0249","FALLON - FALLON HMO STANDARD - Q0249 - TOCILIZUMAB FOR COVID-19","FALLON","FALLON HMO STANDARD","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J3590","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,420.34,420.34,1218,304.5]
["AETNA - AETNA MCR SUPP - HCPCS - J3301","AETNA - AETNA MCR SUPP - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","AETNA","AETNA MCR SUPP","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.94,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - J7608","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - J7608 - ACETYLCYSTEINE NON-COMP UNIT","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON POS STANDARD - HCPCS - A9576","FALLON - FALLON POS STANDARD - A9576 - INJ PROHANCE MULTIPACK","FALLON","FALLON POS STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - HCPCS - P9047","TUFTS CONNCARE/QHP - TUFTS QHP BRONZE SUBSIDIZED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,420.34,50.13,456.36,46.75]
["FALLON - FALLON POS STANDARD - HCPCS - C9257","FALLON - FALLON POS STANDARD - C9257 - PR BEVACIZUMAB INJECTION","FALLON","FALLON POS STANDARD","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,17.5,1.68,456.36,8.75]
["AETNA - AETNA STUDENT HEALTH - HCPCS - J8540","AETNA - AETNA STUDENT HEALTH - J8540 - PR ORAL DEXAMETHASONE","AETNA","AETNA STUDENT HEALTH","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.53,0.09,456.36,0.25]
["FALLON - FALLON POS STANDARD - HCPCS - J0583","FALLON - FALLON POS STANDARD - J0583 - PR BIVALIRUDIN","FALLON","FALLON POS STANDARD","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - C9257","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - C9257 - PR BEVACIZUMAB INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.56,1.68,456.36,8.75]
["FALLON - FALLON POS STANDARD - HCPCS - J0702","FALLON - FALLON POS STANDARD - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","FALLON","FALLON POS STANDARD","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J0702","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["FALLON - FALLON POS STANDARD - HCPCS - J1250","FALLON - FALLON POS STANDARD - J1250 - PR INJ DOBUTAMINE HCL/250 MG","FALLON","FALLON POS STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.5,3.24,456.36,2.25]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J1250","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J1250 - PR INJ DOBUTAMINE HCL/250 MG","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,5.81,3.24,456.36,2.25]
["BCBS - BCBS STANDARD - HCPCS - J3010","BCBS - BCBS STANDARD - J3010 - PR FENTANYL CITRATE INJECITON","BCBS","BCBS STANDARD","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3010","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["FALLON - FALLON POS STANDARD - HCPCS - J2598","FALLON - FALLON POS STANDARD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","FALLON","FALLON POS STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,75.5,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - J3590","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["FALLON - FALLON POS STANDARD - HCPCS - J3010","FALLON - FALLON POS STANDARD - J3010 - PR FENTANYL CITRATE INJECITON","FALLON","FALLON POS STANDARD","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - HCPCS - P9047","TUFTS CONNCARE/QHP - TUFTS QHP GOLD NON SUBSIDIZED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,73.5,50.13,456.36,46.75]
["FALLON - FALLON POS STANDARD - HCPCS - J3301","FALLON - FALLON POS STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","FALLON","FALLON POS STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,420.34,1.58,456.36,1.25]
["FALLON - FALLON POS STANDARD - HCPCS - J3590","FALLON - FALLON POS STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","FALLON","FALLON POS STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,609,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,420.34,55,456.36,66.61]
["FALLON - FALLON POS STANDARD - HCPCS - J7307","FALLON - FALLON POS STANDARD - J7307 - ETONOGESTREL IMPLANT SYSTEM","FALLON","FALLON POS STANDARD","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,420.34,3.24,456.36,2.25]
["FALLON - FALLON POS STANDARD - HCPCS - J7608","FALLON - FALLON POS STANDARD - J7608 - ACETYLCYSTEINE NON-COMP UNIT","FALLON","FALLON POS STANDARD","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON - FALLON POS STANDARD - HCPCS - J8540","FALLON - FALLON POS STANDARD - J8540 - PR ORAL DEXAMETHASONE","FALLON","FALLON POS STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.5,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,420.34,0.98,456.36,3.75]
["FALLON - FALLON POS STANDARD - HCPCS - P9047","FALLON - FALLON POS STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","FALLON","FALLON POS STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J7307","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J7307 - ETONOGESTREL IMPLANT SYSTEM","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,420.34,420.34,2688.55,790.75]
["FALLON - FALLON POS STANDARD - HCPCS - Q0249","FALLON - FALLON POS STANDARD - Q0249 - TOCILIZUMAB FOR COVID-19","FALLON","FALLON POS STANDARD","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,420.34,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - HCPCS - J3590","AETNA - AETNA MCR SUPP - J3590 - PR UNCLASSIFIED BIOLOGICS","AETNA","AETNA MCR SUPP","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,644.32000000000005,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - HCPCS - Q0249","TUFTS CONNCARE/QHP - TUFTS QHP GOLD SUBSIDIZED - Q0249 - TOCILIZUMAB FOR COVID-19","TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,420.34,3.24,456.36,2.25]
["FALLON - FALLON PPO STANDARD - HCPCS - A9576","FALLON - FALLON PPO STANDARD - A9576 - INJ PROHANCE MULTIPACK","FALLON","FALLON PPO STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,2.5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["FALLON - FALLON PPO STANDARD - HCPCS - C9257","FALLON - FALLON PPO STANDARD - C9257 - PR BEVACIZUMAB INJECTION","FALLON","FALLON PPO STANDARD","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,17.5,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["FALLON - FALLON PPO STANDARD - HCPCS - J0583","FALLON - FALLON PPO STANDARD - J0583 - PR BIVALIRUDIN","FALLON","FALLON PPO STANDARD","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,133.22,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["FALLON - FALLON PPO STANDARD - HCPCS - J0702","FALLON - FALLON PPO STANDARD - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","FALLON","FALLON PPO STANDARD","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,63,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON - FALLON PPO STANDARD - HCPCS - J1250","FALLON - FALLON PPO STANDARD - J1250 - PR INJ DOBUTAMINE HCL/250 MG","FALLON","FALLON PPO STANDARD","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,4.5,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["BCBS - BCBS STANDARD - HCPCS - J3301","BCBS - BCBS STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","BCBS","BCBS STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM NON SUBSIDIZED - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["FALLON - FALLON PPO STANDARD - HCPCS - J2598","FALLON - FALLON PPO STANDARD - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","FALLON","FALLON PPO STANDARD","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,75.5,36.299999999999997,456.36,37.75]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - J3590","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - J3590 - PR UNCLASSIFIED BIOLOGICS","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J3010","FALLON - FALLON PPO STANDARD - J3010 - PR FENTANYL CITRATE INJECITON","FALLON","FALLON PPO STANDARD","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.26,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - C9257","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - C9257 - PR BEVACIZUMAB INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,420.34,1.68,456.36,8.75]
["FALLON - FALLON PPO STANDARD - HCPCS - J3301","FALLON - FALLON PPO STANDARD - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","FALLON","FALLON PPO STANDARD","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J0702","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,420.34,7.07,456.36,31.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J3590","FALLON - FALLON PPO STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","FALLON","FALLON PPO STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,609,420.34,1218,304.5]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3010","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J3010 - PR FENTANYL CITRATE INJECITON","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["FALLON - FALLON PPO STANDARD - HCPCS - J7307","FALLON - FALLON PPO STANDARD - J7307 - ETONOGESTREL IMPLANT SYSTEM","FALLON","FALLON PPO STANDARD","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3010","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON PPO STANDARD - HCPCS - J7608","FALLON - FALLON PPO STANDARD - J7608 - ACETYLCYSTEINE NON-COMP UNIT","FALLON","FALLON PPO STANDARD","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J3590","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,420.34,420.34,1218,304.5]
["FALLON - FALLON PPO STANDARD - HCPCS - J8540","FALLON - FALLON PPO STANDARD - J8540 - PR ORAL DEXAMETHASONE","FALLON","FALLON PPO STANDARD","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.5,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - J7608","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - J7608 - ACETYLCYSTEINE NON-COMP UNIT","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON PPO STANDARD - HCPCS - P9047","FALLON - FALLON PPO STANDARD - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","FALLON","FALLON PPO STANDARD","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,93.5,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - HCPCS - P9047","TUFTS CONNCARE/QHP - TUFTS QHP PLATINUM SUBSIDIZED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,420.34,50.13,456.36,46.75]
["FALLON - FALLON PPO STANDARD - HCPCS - Q0249","FALLON - FALLON PPO STANDARD - Q0249 - TOCILIZUMAB FOR COVID-19","FALLON","FALLON PPO STANDARD","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,4.5,3.24,456.36,2.25]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - A9576","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - A9576 - INJ PROHANCE MULTIPACK","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["AETNA - AETNA MCR SUPP - HCPCS - J7307","AETNA - AETNA MCR SUPP - J7307 - ETONOGESTREL IMPLANT SYSTEM","AETNA","AETNA MCR SUPP","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1673.23,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - C9257","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - C9257 - PR BEVACIZUMAB INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,2.56,1.68,456.36,8.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - A9576","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - A9576 - INJ PROHANCE MULTIPACK","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J0702","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - C9257","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - C9257 - PR BEVACIZUMAB INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["BCBS OUT OF STATE - BCBS OUT OF STATE HMO - HCPCS - J3301","BCBS OUT OF STATE - BCBS OUT OF STATE HMO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","BCBS OUT OF STATE","BCBS OUT OF STATE HMO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0583","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J0583 - PR BIVALIRUDIN","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3010","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J0702","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - J3590","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J1250","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J1250 - PR INJ DOBUTAMINE HCL/250 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - HCPCS - P9047","TUFTS CONNCARE/QHP - TUFTS QHP SILVER NON SUBSIDIZED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,73.5,50.13,456.36,46.75]
["BCBS - BCBS STANDARD - HCPCS - J3590","BCBS - BCBS STANDARD - J3590 - PR UNCLASSIFIED BIOLOGICS","BCBS","BCBS STANDARD","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,420.34,1.58,456.36,1.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J2598","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,420.34,55,456.36,66.61]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3010","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J3010 - PR FENTANYL CITRATE INJECITON","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,420.34,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3301","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,420.34,36.299999999999997,456.36,37.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J3590","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J3590 - PR UNCLASSIFIED BIOLOGICS","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,420.34,0.98,456.36,3.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - J8540","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - J8540 - PR ORAL DEXAMETHASONE","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J7307","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J7307 - ETONOGESTREL IMPLANT SYSTEM","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,420.34,420.34,2688.55,790.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG POS - HCPCS - P9047","FALLON MEDICARE MANAGED - FALLON MCG MNG POS - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","FALLON MEDICARE MANAGED","FALLON MCG MNG POS","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,53.08,50.13,456.36,46.75]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,420.34,0.09,456.36,0.25]
["AETNA - AETNA MCR SUPP - HCPCS - J7608","AETNA - AETNA MCR SUPP - J7608 - ACETYLCYSTEINE NON-COMP UNIT","AETNA","AETNA MCR SUPP","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,7,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - HCPCS - Q0249","TUFTS CONNCARE/QHP - TUFTS QHP SILVER SUBSIDIZED - Q0249 - TOCILIZUMAB FOR COVID-19","TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED","HCPCS","Q0249","TOCILIZUMAB FOR COVID-19","Q0249 - TOCILIZUMAB FOR COVID-19",9,420.34,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - A9576","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - A9576 - INJ PROHANCE MULTIPACK","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - A9576","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - A9576 - INJ PROHANCE MULTIPACK","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - C9257","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - C9257 - PR BEVACIZUMAB INJECTION","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,1.85,1.68,456.36,8.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J0583","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J0583 - PR BIVALIRUDIN","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0583","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J0583 - PR BIVALIRUDIN","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J0583","PR BIVALIRUDIN","J0583 - PR BIVALIRUDIN",266.44,266.44,55,456.36,66.61]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J1250","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J1250 - PR INJ DOBUTAMINE HCL/250 MG","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J0702","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J2598","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,50.26,36.299999999999997,456.36,37.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J1250","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J1250 - PR INJ DOBUTAMINE HCL/250 MG","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J1250","PR INJ DOBUTAMINE HCL/250 MG","J1250 - PR INJ DOBUTAMINE HCL/250 MG",9,9,3.24,456.36,2.25]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J3301","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["BCBS - BCBS STANDARD - HCPCS - J7307","BCBS - BCBS STANDARD - J7307 - ETONOGESTREL IMPLANT SYSTEM","BCBS","BCBS STANDARD","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1318.16,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - HCPCS - J8540","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD NON SUBSIDIZED - J8540 - PR ORAL DEXAMETHASONE","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J2598","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J2598 - PR INJ, VASOPRESSIN, 1 UNIT","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J2598","PR INJ, VASOPRESSIN, 1 UNIT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",150.99,36.299999999999997,36.299999999999997,456.36,37.75]
["AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - HCPCS - J0702","AETNA MEDICARE MANAGED - AETNA MEDICARE MANAGED STANDARD - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,126,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3010","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J3010 - PR FENTANYL CITRATE INJECITON","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,0.52,0.19,456.36,0.13]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - C9257","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - C9257 - PR BEVACIZUMAB INJECTION","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","C9257","PR BEVACIZUMAB INJECTION","C9257 - PR BEVACIZUMAB INJECTION",35,420.34,1.68,456.36,8.75]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3301","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,15,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J0702","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J0702 - PR BETAMETHASONE ACET&SOD PHOSP","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J0702","PR BETAMETHASONE ACET&SOD PHOSP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",126,420.34,7.07,456.36,31.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J3590","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J3590 - PR UNCLASSIFIED BIOLOGICS","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,1218,420.34,1218,304.5]
["FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - HCPCS - J8540","FALLON MEDICARE MANAGED - FALLON MCG MNG PPO - J8540 - PR ORAL DEXAMETHASONE","FALLON MEDICARE MANAGED","FALLON MCG MNG PPO","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3301","FALLON - FALLON COMMUNITY PLAN - J3301 - PR TRIAMCINOLONE ACETONIDE INJ","FALLON","FALLON COMMUNITY PLAN","HCPCS","J3301","PR TRIAMCINOLONE ACETONIDE INJ","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",15,7.5,0.98,456.36,3.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3010","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J3010 - PR FENTANYL CITRATE INJECITON","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J3010","PR FENTANYL CITRATE INJECITON","J3010 - PR FENTANYL CITRATE INJECITON",0.52,420.34,0.19,456.36,0.13]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J3590","FALLON - FALLON COMMUNITY PLAN - J3590 - PR UNCLASSIFIED BIOLOGICS","FALLON","FALLON COMMUNITY PLAN","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,609,420.34,1218,304.5]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J3590","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J3590 - PR UNCLASSIFIED BIOLOGICS","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J3590","PR UNCLASSIFIED BIOLOGICS","J3590 - PR UNCLASSIFIED BIOLOGICS",1218,420.34,420.34,1218,304.5]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7307","FALLON - FALLON COMMUNITY PLAN - J7307 - ETONOGESTREL IMPLANT SYSTEM","FALLON","FALLON COMMUNITY PLAN","HCPCS","J7307","ETONOGESTREL IMPLANT SYSTEM","J7307 - ETONOGESTREL IMPLANT SYSTEM",3163,1581.5,420.34,2688.55,790.75]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - J7608","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - J7608 - ACETYLCYSTEINE NON-COMP UNIT","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,420.34,4.7699999999999996,456.36,3.31]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J7608","FALLON - FALLON COMMUNITY PLAN - J7608 - ACETYLCYSTEINE NON-COMP UNIT","FALLON","FALLON COMMUNITY PLAN","HCPCS","J7608","ACETYLCYSTEINE NON-COMP UNIT","J7608 - ACETYLCYSTEINE NON-COMP UNIT",13.24,6.62,4.7699999999999996,456.36,3.31]
["TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - HCPCS - P9047","TUFTS CONNCARE/QHP - TUFTS QHP STANDARD SUBSIDIZED - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,420.34,50.13,456.36,46.75]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - J8540","FALLON - FALLON COMMUNITY PLAN - J8540 - PR ORAL DEXAMETHASONE","FALLON","FALLON COMMUNITY PLAN","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,0.5,0.09,456.36,0.25]
["FALLON - FALLON COMMUNITY PLAN - HCPCS - P9047","FALLON - FALLON COMMUNITY PLAN - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","FALLON","FALLON COMMUNITY PLAN","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,93.5,50.13,456.36,46.75]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - J8540","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - J8540 - PR ORAL DEXAMETHASONE","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","J8540","PR ORAL DEXAMETHASONE","J8540 - PR ORAL DEXAMETHASONE",1,1,0.09,456.36,0.25]
["AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - HCPCS - A9576","AARP UHC MEDICARE COMPLETE - AARP UHC MCR COMPLETE PPO NON CONTRACTED - A9576 - INJ PROHANCE MULTIPACK","AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED","HCPCS","A9576","INJ PROHANCE MULTIPACK","A9576 - INJ PROHANCE MULTIPACK",5,5,1.58,456.36,1.25]
["CORRECTIONS - ZZZCORRECTIONS PONDVILLE - HCPCS - P9047","CORRECTIONS - ZZZCORRECTIONS PONDVILLE - P9047 - PR ALBUMIN (HUMAN), 25%, 50ML","CORRECTIONS","ZZZCORRECTIONS PONDVILLE","HCPCS","P9047","PR ALBUMIN (HUMAN), 25%, 50ML","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",187,55.73,50.13,456.36,46.75]

{"sheet":"EPIC Proc Codes","index":23,"n_rows":70244,"n_cols":13,"rows_kept":2250,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
["proc_code","PROC_NAME",null,null,null,null,null,null,null,null,null,null,"select a.proc_code, a.PROC_NAME"]
["0","NO CHARGE - IP",null,null,null,null,null,null,null,null,null,null,"from"]
["00000","NO CHARGE - IP",null,null,null,null,null,null,null,null,null,null,"("]
["00001","SUBMIT FOR CODING REVIEW",null,null,null,null,null,null,null,null,null,null,"select eap.proc_code, eap.proc_name, ROW_NUMBER() OVER (PARTITION BY eap.proc_code ORDER BY eap.proc_id desc) rn"]
["00001000","HC CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL-MDPH",null,null,null,null,null,null,null,null,null,null,"from clarity.dbo.clarity_eap eap "]
["00002","BYPASS CODING REVIEW",null,null,null,null,null,null,null,null,null,null,")a"]
["00002000","HC 2019 NOVELCORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL",null,null,null,null,null,null,null,null,null,null,"where a.rn = 1"]
["00004000","HC 2019-NCOV CORONAVIRUS SARS-COV-2/2019-NCOV"]
["00005000","HC INFEC AGEN DETEC AMPLI PROBE",null,null,null,null,null,null,null,null,null,null,"order by proc_code"]
["00008001","HC ADMIN INFLUENZA VIRUS VAC"]
["00008101","HC ADMIN INFLUENZA VIRUS VAC"]
["00009001","HC ADMIN PNEUMOCOCCAL VACCINE"]
["00009101","HC ADMIN PNEUMOCOCCAL VACCINE"]
["00010001","HC ADMIN HEPATITIS B VACCINE"]
["00010101","HC ADMIN HEPATITIS B VACCINE"]
["0001A","ADM SARSCOV2 30MCG/0.3ML 1ST"]
["0001A001","HC ADM SARSCOV2 30MCG/0.3ML 1ST"]
["0001F","PR HEART FAILURE COMPOSITE ASSESSMENT"]
["0001U","PR RBC DNA HEA 35 AG 11 BLD GRP WHL BLD CMN ALLEL"]
["0002A","ADM SARSCOV2 30MCG/0.3ML 2ND"]
["0002A001","HC ADM SARSCOV2 30MCG/0.3ML 2ND"]
["0002U","PR ONC CLRCT QUAN 3 UR METABOLITES ALG ADNMTS PLP"]
["0003A","ADM SARSCOV2 30MCG/0.3ML 3RD IMMCOMP/HGHRSK 28DYS"]
["0003A001","HC ADM SARSCOV2 30MCG/0.3ML 3RD"]
["0003T","PR CERVICOGRAPHY"]
["0003U","PR ONC OVARIAN ASSAY 5 PROTEINS SERUM ALG SCOR"]
["0004A","ADM SARSCOV2 30MCG/0.3ML BST NON-CMP/HGHRSK 6MTHS"]
["0004A001","HC ADM SARSCOV2 30MCG/0.3ML BST NON-IMMCMP -6MTHS"]
["0004U","PR NFCT DS DNA 27 RESIST GENES BCT CUL PR ISOL"]
["0005F","PR OSTEOARTHRITIS COMPOSITE ASSESSMENT"]
["0005U","PR ONCO PRST8 GENE XPRS PRFL 3 GENE UR ALG RSK SCOR"]
["0006U","CHG DETCJ IA MEDS SBST SUPPL & FOODS 120+ ANALYTES"]
["00076001","HC PROLOTHERAPY"]
["0007U","PR RX TEST PRESUMPTIVE URINE W/DEF CONFIRMATION"]
["0008T","PR UP GI ENDOSCOP, W/SUTURE ESOPHAGOGAS JCT"]
["0008U","PR HPYLORI DETECTION & ANTIBIOTIC RESISTANCE DNA"]
["00091001","HC OBTAINING SCREEN PAP SMEAR"]
["0009U","PR ONC BRST CA ERBB2 COPY NUMBER FISH AMP/NONAMP"]
["000G0019","HC COMM HLTH INTG SVS SDOH 60MN"]
["000G0022","HC COMM HLTH INTG SVS ADD 30 M"]
["000G0023","HC PIN SERVICE 60M PER MONTH"]
["000G0024","HC PIN SRV ADD 30 MIN PR M"]
["000G0140","HC NAV SRV PEER SUP 60 MIN PR M"]
["000G0146","HC NAV SRV PEER SUP ADD 30 PR M"]
["00100","PR ANESTH,SALIVARY GLAND W/BX"]
["00101001","HC CA SCREEN;PELVIC/BREAST EXAM"]
["00102","PR ANESTH,CLEFT LIP REPAIR"]
["00103","PR ANESTH,BLEPHAROPLASTY"]
["00103000","HC PSA, TOTAL SCREENING"]
["00104","PR ANESTH,ELECTROSHOCK/ ECT"]
["00105001","HC COLORECTAL SCRN; HI RISK IND"]
["00108001","HC DIAB MANAGE TRN PER INDIV"]
["00109001","HC DIAB MANAGE TRN IND/GROUP"]
["0010T","PR TB TEST, CELL MED IMM, GAMMA INTERFER AG"]
["0010U","PR NFCT DS STRN TYP WHL GENOME SEQUENCING PR ISO"]
["00111001","HC WET MOUNTS W/PREPARATIONS"]
["00112001","HC POTASSIUM HYDROXIDE PREPS"]
["00114000","HC  FERN TEST"]
["0011A","ADM SARSCOV2 100MCG/0.5ML1ST"]
["0011A001","HC ADM SARSCOV2 100MCG/0.5ML1ST"]
["0011U","PR RX MNTR DRUGS PRESENT LC-MS/MS ORAL FLUID PR DOS"]
["00120","PR ANESTH,EAR SURGERY"]
["00120000","HC OROFACIAL PAIN EST"]
["00120001","HC PERIODIC EVAL"]
["00124","PR ANESTH,EAR EXAM"]
["00126","PR ANESTH,TYMPANOTOMY"]
["00127001","HC TRIM NAIL(S)"]
["0012A","ADM SARSCOV2 100MCG/0.5ML2ND"]
["0012A001","HC ADM SARSCOV2 100MCG/0.5ML2ND"]
["0012F","PR BACT COMMUNITY-ACQUIRED PNEUMONIA ASSESSMENT"]
["0012U","PR GERMLN DO GENE REARGMT DETCJ DNA WHOLE BLOOD"]
["00138001","HC IV CIPAGLUCOSIDASE ALFA-ATGA"]
["0013A","ADM SARSCOV2 100MCG/0.5ML 3RD"]
["0013A001","HC ADM SARSCOV2 100MCG/0.5ML 3RD"]
["0013U","PR ONC SLD ORGN NEO GENE REARGMT DNA FRSH FRZN TISS"]
["00140","PR ANESTH,PROCEDURES ON EYE"]
["00140001","HC LIMITED EVAL"]
["00142","PR ANESTH, LENS SURGERY"]
["00144","PR ANESTH,CORNEAL TRANSPLANT"]
["00144001","HC UDL; AZITHROMY 1GM PKT"]
["00145","PR ANESTH, VITREORETINAL SURG"]
["00145001","HC ORAL EVAL<3YRS-COUN CAREG"]
["00147","PR ANESTH,IRIDECTOMY"]
["00148","PR ANESTH,EYE EXAM"]
["0014F","PR COMP PREOP ASSESS CATARACT SURG W/ IOL PLACEMENT"]
["0014U","PR HEM HMTLMF NEO GENE REARGMT DNA WHL BLD/MARROW"]
["00150001","HC DENTURE,INITIAL VST"]
["0015F","PR MELANOMA FOLLOW UP COMPLETED"]
["0015U","PR RX METAB ADVRS RX RXN DNA 22 GENES BLD/BUCCAL"]
["00160","PR ANESTH,NOSE,SINUS SURGERY"]
["00160001","HC DETAILED, BY REPORT"]
["00162","PR ANESTH,NOSE,RADICAL SINUS SURGERY"]
["00164","PR ANESTH,BIOPSY OF NOSE"]
["0016T","DESTR LOC LES, CHOROIDS, TRANSPUP THERM"]
["0016U","PR ONC HMTLMF NEO RNA BCR/ABL1 BLD/BNE MARROW"]
["00170","PR ANESTH,PROCEDURE ON MOUTH"]
["00170001","HC RE-EVAL - LIMITED/FOCUSED"]
["00172","PR ANESTH,CLEFT PALATE REPAIR"]
["00174","PR ANESTH,EXCIS RETROPHARYNG TUMOR"]
["00175001","HC OPPS SERVICE,SCHED TEAM CONF"]
["00176","PR ANESTH,PHARYNX SURG RADICAL"]
["0017T","DESTR, MACULAR DRUSEN, PHOTOCOAGULATION"]
["0017U","PR ONC HMTLMF NEO JAK2 MUTATION DNA BLD/BNE MARROW"]
["0018T","PR DELIV FOC MAG PUL, DR STIM, CORT NEURONS"]
["0018U","CHG ONC THYR 10 MICRORNA SEQ +/- RSLT MOD HI RSK MAL"]
["00190","PR ANESTH,FACIAL BONE SURGERY"]
["00192","PR ANESTH,RADICAL FACIAL BONE SURGERY"]
["0019T","PR EXTRACORP SHOCKWAVE, MUSC/SKEL, LOW ENERGY, NOS"]
["0019U","CHG ONC RNA WHL TRANSCIPTOME SEQ TISS PREDCT ALG"]
["00201001","ADMIN PCV, FLU, HEP B, &/OR COVID 19 VACC HOME ADMIN"]
["0020T","PR EXTRACORP SHOCK WAVE THER; PLANT FASCIA"]
["0020U","CHG RX TEST PRSMV UR W/DEF CONF"]
["00210","PR ANESTH,OPEN HEAD SURGERY"]
["00210001","HC INTRAORAL-COMPLETE SERIES"]
["00211","PR ANESTH, INTRACRANIAL HEMATOMA EVACUATION"]
["00212","PR ANESTH,SKULL SURG SUBDUR TAP"]
["00214","PR ANESTH,SKULL SURG BURR HOLE"]
["00215","PR ANESTH, CRANIOPLASTY"]
["00216","PR ANESTH,HEAD VESSEL SURGERY"]
["00218","PR ANESTH,SPECIAL HEAD SURGERY"]
["0021A001","HC ADM SARSCOV2 5X10 10VP 5ML 1"]
["0021T","PR INSERT, TRANSCERV FETAL OXIMETRY PROBE"]
["0021U","CHG ONC PRST8 DETCJ 8 AUTOANTIBODIES ALG RSK SCOR"]
["00220","PR ANESTH,INTRACRAN PROC; CSF SHUNT PROC"]
["00220001","HC PERIAPICAL - FIRST"]
["00222","PR ANESTH,INTRACRAN NERVE COAGULATN"]
["00224001","HC PEMIVIBART INFUSION"]
["0022A001","HC ADM SARSCOV2 5X1010VP 5ML 2"]
["0022U","CHG TRGT GEN SEQ ALYS NONSM LNG NEO DNA&RNA 23 GENES"]
["00230001","HC PERICAPICAL ADD FILM"]
["00239001","HC THER,IMPR-GROUP"]
["0023T","PR DRUG SUS PHEN PRED, GENOTYPIC COMP HIV 1"]
["0023U","CHG ONC AML DNA GNTYP INT TANDEM DUP DETCJ/NONDETCJ"]
["0023U001","HC ONC AML DNA GNTYP INT TANDEM DUP DETCJ/NONDETCJ"]
["0023U002","HC FLT3 ITD AND TKD MUTATION"]
["00240001","HC OCCLUSAL - INTRAORAL"]
["00244001","HC CASIRIVI AND IMDEVI 1200 MG"]
["0024T","NON-SUR SEPT RED W/COR ARTER, W/WO PACER"]
["0024U","CHG GLYCA NUC MR SPECTROSCOPY QUANTITATIVE"]
["00250001","HC PR OROFACIAL PAIN NEW"]
["00251001","HC EXTRA-ORAL POSTERIOR DENTAL RADIOGRAPHIC IMAGE"]
["00257001","HC UNSCHED DIALYSIS ESRD PT HOSP"]
["00259001","HC INJECT FOR SACROILIAC JOINT"]
["0025U","CHG TENOFOVIR LIQ CHROM TANDEM MASS SPECT UR QUAN"]
["00269000","HC CLOSURE DEVICE PLACEMENT"]
["0026T","LIPOPROTEIN, DIR MEAS IDL (REMNANT)"]
["0026U","CHG ONC THYR DNA&MRNA 112 GENES FNA NDUL ALG ALYS"]
["00270000","HC MNT SUBS TX FOR CHANGE DX"]
["00270001","HC BITEWING SINGLE FILM"]
["00272001","HC BITEWINGS 2 FILMS"]
["00274001","HC BITEWINGS 4 FILMS"]
["00277001","HC VERTICAL BITEWINGS - 7 TO 8 RADIOGRAPHIC IMAGES"]
["00279000","HC TOMOSYNTHESIS, MAMMO"]
["0027T","ENDOSC LYSIS EPIDUR ADHES, SOLN INJ/MECH"]
["0027U","CHG JAK2 GENE ANALYSIS TRGT SEQ ALYS EXONS 12-15"]
["0028T","DUAL ENERGY X-RAY ABSORPT, 1+ SITES"]
["0028U","CHG CYP2D6 GENE CPY NMR CMN VRNT"]
["00296001","HC VISIT TO DETERM LDCT ELIG"]
["00297000","HC LDCT FOR LUNG CA SCREEN"]
["0029T","TREAT INCONT, PULS MAG NEUROMOD, PER DAY"]
["0029U","CHG RX METAB ADVRS RX RXN & RSPSE TRGT SEQ ALYS"]
["00300","PR ANESTH,SKIN SURG HEAD/NECK"]
["0030T","PR ANTIPROTHROMBIN ANTIBODY, EA IG CLASS"]
["0030U","CHG RX METAB WARFARIN RX RESPONSE TRGT SEQ ALYS"]
["0031A","ADM SARSCOV2 VAC AD26 .5ML"]
["0031A001","HC ADM SARSCOV2 VAC AD26 .5ML"]
["0031T","SPECULOSCOPY"]
["0031U","CHG CYP1A2 GENE ANALYSIS COMMON VARIANTS"]
["00320","PR ANESTH,NECK ORG PROC; NOS, AGE 1 YR/OLD"]
["00322","PR ANESTH,NEEDLE BX THYROID"]
["00326","PR ANESTH,LARYNX/TRACH PROC; CHILDREN <1 YR"]
["0032T","SPECULOSCOPY; W/DIRECTED SAMPLING"]
["0032U","CHG COMT GENE ANALYSIS C.472G>A VARIANT"]
["00330001","HC PANORAMIC FILM"]
["0033T","PR ENDOV REP DES THOR AA/DIS W/ L SUBCLAV"]
["0033U","CHG HTR2A HTR2C GENE ANALYSIS COMMON VARIANTS"]
["0034A","IMM ADMN SARSCOV2 AD26 5X1010 VP/0.5 ML BST DOSE"]
["0034A001","HC IMM ADMN SARSCOV2 AD26 5X1010 VP/0.5 ML BST DOSE"]
["0034T","PR ENDOV REP DES THOR AA/DIS W/O L SUBCLAV"]
["0034U","CHG TPMT NUDT15 GENE ANALYSIS COMMON VARIANTS"]
["00350","PR ANESTH,NECK VESSEL SURGERY NOS"]
["00350001","HC ORAL/FACIAL IMAGES"]
["00352","PR ANESTH,NECK VESSEL SURG SIMPL LIGAT"]
["0035T","PR PLACE EXT PROS, DES THOR AA/DIS; INI EXT"]
["0035U","CHG NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL"]
["00365001","HC VESSEL MAPPING HEMO ACCESS"]
["0036T","PR PLACE EXT PROS, DES THOR AA/DIS; EA ADDL"]
["0036U","CHG EXOME TUMOR TISSUE & NORMAL SPECIMEN SEQ ALYS"]
["00378001","HC HOSPITAL OBSERVATION PER HR"]
["00379001","HC DIRECT REFER HOSPITAL OBSERV"]
["0037T","PR SUBCLA-CAROT ART TRANS, W/THOR ANEUR REP"]
["0037U","CHG TRGT GEN SEQ ALYS SLD ORGN NEO DNA 324 GENES"]
["0038T","PR ENDO REP DES TAA/DIS W/ L SUBCL RAD S&I"]
["0038U","CHG VITAMIN D SERUM MICROSAMPLE QUANTITATIVE"]
["00390001","HC TRAUMA RESPONS W/HOSP CRITI"]
["00396001","HC ALCOHOL/SUBS INTERV 15-30MN"]
["00397001","HC ALCOHOL/SUBS INTERV >30 MIN"]
["00399001","HC HOME SLEEP TEST/TYPE 3 PORTA"]
["0039T","PR ENDO REP DES TAA/DIS W/O L SUBCL RAD S&I"]
["0039U","CHG DNA ANTIBODY DOUBLE STRANDED HIGH AVIDITY"]
["00400","PR ANESTH,SKIN SURG THORAX/EXTR"]
["00402","PR ANESTH,SURG BREAST RECONSTRUCTIVE"]
["00402001","HC INITIAL PREVENTIVE EXAM"]
["00404","PR ANESTH,SURG BREAST RAD MASTEC"]
["00404001","HC EKG TRACING FOR INITIAL PREV"]
["00406","PR ANESTH,SURG BREAST RAD MAST W NODE"]
["0040T","PR PLACE EXT PROS, DES THOR AA/DIS, RAD S&I"]
["0040U","CHG BCR/ABL1 GENE TLCJ ALYS MAJOR BP QUANTITATIVE"]
["00410","PR ANESTH,CORRECT HEART RHYTHM"]
["00410001","HC GRP PSYCH PARTIAL HOSP OR INTENS OP 45-50"]
["00416000","HC PROSTATE BIOPSY ANY MTHD"]
["00416001","HC VIRAL CULTURE"]
["0041A","ADM SARSCOV2 5MCG/0.5ML 1ST"]
["0041A001","HC ADM SARSCOV2 5MCG/0.5ML 1ST"]
["0041T","URINALYSIS, SEMI-QUANT ANAL VOL CMPNDS"]
["0041U","CHG B BURGDORFERI ANTB 5 PRTN GRP IMMUNOBLOT IGM"]
["00420001","HC ED SVC CKD IND PER SESSION"]
["00421001","HC ED SVC CKD GRP PER SESSION"]
["00422001","HC INTENS CARDIAC REHAB W/EXERC"]
["00423001","HC INTENS CARDIAC REHAB NO EXER"]
["00424001","HC PULMONARY REHAB, 1HR"]
["0042A","ADM SARSCOV2 5MCG/0.5ML 2ND"]
["0042A001","HC ADM SARSCOV2 5MCG/0.5ML 2ND"]
["0042T","PR CERBRAL PERFUSION STUDY, CT W/ CONTRAST"]
["0042T000","HC CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME"]
["0042U","CHG B BURGDORFERI ANTB 12 PRTN GRP IMMUNOBLOT IGG"]
["00431001","HC DIAG TST DETECT MUCOS ABNORM"]
["00438001","HC PPPS, INITIAL VISIT"]
["00439001","HC PPPS, SUBSEQ VISIT"]
["0043T","CARBON MONOXIDE, EXPIRED GAS ANALYSIS"]
["0043U","CHG TBRF B GRP ANTB DETCJ 4 RECOMB PRTN IMUNOBLT IGM"]
["00442001","HC ANNUAL ALCOHOL SCREEN 5 TO 15 MIN"]
["00443001","HC BRIEF ALCOHOL MISUSE COUNSEL"]
["00444001","HC DEPRESSION SCREEN ANNUAL 5 TO 15 MIN"]
["00445001","HC HIGH INTEN BEH COUNS STD 30M"]
["00446001","HC INTENS BEHAVE THER CARDIO DX"]
["00447001","HC BEHAVIOR COUNSEL OBESITY 15M"]
["0044A","ADM SARSCOV2 5MCG/0.5ML BST"]
["0044A001","HC ADM SARSCOV2 5MCG/0.5ML ADL"]
["0044T","PR WHOLE BODY SKIN PHOTO, PHYS REQUEST"]
["0044U","CHG TBRF B GRP ANTB DETCJ 4 RECOMB PRTN IMUNOBLT IGG"]
["00450","PR ANESTH,SURG CLAVICLE/SCAPULA"]
["00452","PR ANESTH,RAD SURG CLAVICLE/SCAPULA"]
["00454","PR ANESTH,CLAVICLE BIOPSY"]
["00455001","HC FECAL MICROBIOTA PREP INSTIL"]
["0045T","PR WHOLE BODY PHOTOGRAPHY"]
["0045U","CHG ONC BRST DUX CARC IS MRNA 12 GENES ALG RSK SCOR"]
["00460001","HC PULP VITALITY TEST"]
["00465001","HC AUTOLOG PRP DIAB WOUND ULCER"]
["0046T","CATH LAVAGE, MAMMARY DUCT(S"]
["0046U","CHG FLT3 GENE INT TANDEM DUPL VARIANTS QUANTITATIVE"]
["00470","PR ANESTH,PARTIAL RIB RESECTN"]
["00470001","HC DIAGNOSTIC CASTS"]
["00472","PR ANESTH,CHEST WALL REPAIR"]
["00472001","HC ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT"]
["00473001","HC ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAM, PREP AND TRANS OF RPT."]
["00473002","HC GROUP BEHAVE OBESITY COUNS 2-10 30MIN"]
["00474","PR ANESTH,CHEST WALL REPAIR EXTENSIVE"]
["00474001","HC ACCESSION OF TISSUE, GROSS AND MICRO EXAM, INCL. ASSESS. OF MARGINS FOR DISEASE, PREP., TX OF RPT"]
["00475001","HC DECALCIFICATION PROCEDURE"]
["00478001","HC IMMUNOHISTOCHEMICAL STAINS"]
["0047T","CATH LAVAGE, MAMMARY DUCT(S)"]
["0047U","CHG ONC PRST8 MRNA GEN XPRS PRFL 17 GEN ALG RSK SCOR"]
["00480000","HC DRUG SCR QUANT ALCOHOL"]
["00480001","HC Q;FENT AND NFENT,U"]
["00480002","HC ACET ANALGESIC NONOPIOID"]
["00481000","HC Q;PAIN MANAG OPIATES QTUR"]
["00481001","HC ELECTRON MICROSCOPY DIAGNOST"]
["00482001","HC DIRECT IMMUNOFLUORESCENCE"]
["00483001","HC INDIRECT IMMUNOFLUORESCENCE"]
["00484001","HC CONSULT SLIDES PREP ELSEWHER"]
["00485001","HC CONSULT INC PREP OF SLIDES"]
["0048T","PR IMPLANT VENTRIC ASSIST DEV, EXTRACORP, TRANSSEPT, SINGLE/DUAL"]
["0048U","CHG ONC SLD ORG NEO DNA 468 CANCER ASSOCIATED GENES"]
["0049T","EXTERNAL CIRCULATION ASSIST"]
["0049U","CHG NPM1 GENE ANALYSIS QUANTITATIVE"]
["00500","PR ANESTH,ESOPHAGEAL SURGERY"]
["00500001","HC SED ENDO SERV 5>/+YO"]
["00502001","HC OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT"]
["00506001","HC COMP ASSESS CARE PLAN CCM SVC"]
["0050T","PR REMOVE VENTRIC ASSIST DEV, EXTRACORP, TRANSSEPT, SINGLE/DUAL"]
["0050U","CHG TRGT GEN SEQ ALYS AML 194 GENE INTERROG SEQ VRNT"]
["00513001","HC PROLONG PREV SVCS, FIRST 30M"]
["00514001","HC PROLONG PREV SVCS, ADDL 30M"]
["0051A","ADM SARSCV2 30MCG TRS-SUCR 1"]
["0051A001","HC ADM SARSCV2 30MCG TRS-SUCR 1"]
["0051T","PR IMPLANT TOTAL REPLACE HEART, INCL RECIP CARDIECTOMY"]
["0051U","CHG RX MNTR DRUGS PRESENT LC-MS/MS UR 31 DRUG PANEL"]
["00520","PR ANESTH,CHEST PROC CLOSED,NOS"]
["00522","PR ANESTH,CHEST PLEURAL BIOPSY"]
["00524","PR ANESTH,CHEST DRAINAGE"]
["00528","PR ANESTH,MEDIASTINOSCOPY"]
["00529","PR ANESTH, CHEST PARTITION VIEW"]
["0052A","ADM SARSCV2 30MCG TRS-SUCR 2"]
["0052A001","HC ADM SARSCV2 30MCG TRS-SUCR 2"]
["0052T","PR REPLACE/REPAIR TOTAL REPLACEMENT HEART, THORACIC UNIT"]
["0052U","CHG LPOPRTN BLD W/5 MAJ CLASS AUTO PRFL UCENTRFUGTN"]
["00530","PR ANESTH,PACEMAKER INSERTION"]
["00532","PR ANESTH,CENTRL VASCULAR ACCESS"]
["00534","PR ANESTH,CARDIOVERTER/DEFIB"]
["00534001","HC ANESTH,CARDIOVERTER/DEFIB"]
["00537","PR ANESTH,CARD ELECTROPHYS PROC"]
["00539","PR ANESTH,TRACHEOBRONCHIAL RECONSTRUCT"]
["0053A","ADM SARSCV2 30MCG TRS-SUCR 3"]
["0053A001","HC ADM SARSCV2 30MCG TRS-SUCR 3"]
["0053T","PR REPLACE/REPAIR TOTAL REPLACEMENT HEART, NON-THORACIC COMPNT"]
["0053U","CHG ONC PRST8 CA FISH ALYS 4 GENES NDL BX SPEC ALG"]
["00540","PR ANESTH,CHEST SURGERY,THORACOTOMY"]
["00541","PR ANESTH,THORACOTOMY PROC, W/1 LUNG VENT"]
["00542","PR ANESTH,CHEST DECORTICATION"]
["00546","PR ANESTH,LUNG RESEC,THORACOPLASTY"]
["00548","PR ANESTH,TRACH,BRONCHI INTRATHOR SURG"]
["0054A","ADM SARSCV2 30MCG TRS-SUCR B"]
["0054A001","HC ADM SARSCV2 30MCG TRS-SUCR B"]
["0054T","PR COMPUTER-ASSIST MUSCSKEL NAVIG, ORTHO PROC, FLUORO"]
["0054U","CHG RX MNTR 14+ CLASS DRUGS & SBSTS CAPILLARY BLOOD"]
["00550","PR ANESTH,STERNAL DEBRIDEMENT"]
["0055T","PR COMPUTER-ASSIST MUSCSKEL NAVIG, ORTHO PROC, CT/MRI"]
["0055U","CHG CARD HRT TRNSPL 96 TARGET DNA SEQUENCES PLASMA"]
["00560","PR ANESTH,OPEN HEART; W/O PUMP OXYEGENATOR"]
["00561","PR ANESTH, HEART SURG < AGE 1"]
["00562","PR ANESTH,OPEN HEART SURGERY+PUMP"]
["00563","PR ANESTH,OPEN HEART,PUMP+HYPOTHERM"]
["00566","PR ANESTH,DIRECT CABG W/O PUMP OXYGENATOR"]
["00567","PR ANESTH, DIRECT CABG W PUMP OXYGENATOR"]
["0056T","BONE SURGERY USING COMPUTER ASSIST, IMAGE LESS"]
["0056U","CHG HEM AML DNA GENE REARRANGEMENT BLOOD/BONE MARROW"]
["0057U","CHG ONC SLD ORG NEO MRNA 51 GENES ALG NML % RANK"]
["00580","PR ANESTH,HEART/LUNG TRANSPLANT"]
["0058T","PR CRYOPRESERVATION REPRODUCTIVE TISSUE, OVARIAN"]
["0058U","CHG ONC MERKEL CELL CARC DETCJ ANTB SERUM QUAN"]
["0059T","PR CRYOPRESERVATION OOCYTES"]
["0059U","CHG ONC MERKEL CELL CARC DETCJ ANTB SERUM REPRTD +/-"]
["00600","PR ANESTH,CERV SPINE,CORD SURGERY"]
["00604","PR ANESTH,CERV SPINE, SITTING POSITION"]
["0060T","ELECTRICAL IMPEDANCE SCAN"]
["0060U","CHG TWN ZYG GEN TRGT SEQ ALYS CHRMS2 FTL DNA MAT BLD"]
["00610001","HC ANNUAL GYNECOLOGICAL EXAMIN, NEW PT"]
["00612001","HC ANNUAL GYNECOLOGICAL EXAMIN, EST PT"]
["0061T","DESTRUCTION OF TUMOR, BREAST"]
["0061U","CHG TC MEAS 5 BIOMARKERS W/SFDI MULTI-SPECTRAL ALYS"]
["00620","PR ANESTH,THOR SPINE,CORD SURGERY"]
["00622","PR ANESTH,THORACOLUMBAR SYMPATHECTOMY"]
["00625","PR ANESTH,TRANSTHORACIC SPINE SURG W/O 1 LUNG VENT"]
["00626","PR ANESTH,TRANSTHORACIC SPINE SURG W/ 1 LUNG VENT"]
["0062T","PERC ANNULOPLASTY, 1 LEVEL"]
["00630","PR ANESTH,LUMBAR SPINE,CORD SURGERY"]
["00632","PR ANESTH,LUMBAR SYMPATHECTOMY"]
["00634","PR ANESTH FOR CHEMONUCLEOLYSIS"]
["00635","PR ANESTH,LUMBAR PUNCTURE"]
["0063T","PERC ANNULOPLASTY, >1 LEVEL"]
["00640","PR ANESTH,CLOSED MANIPULATION, SPINE C/T/L"]
["0064A","ADM SARSCOV2 50MCG/0.25MLBST"]
["0064A001","HC ADM SARSCOV2 50MCG/0.25MLBST"]
["0064T","SPECTROSCOP EVAL EXPIRED GAS"]
["0065T","OCULAR PHOTOSCREEN BILAT"]
["0066T","CT COLONOGRAPHY;SCREEN"]
["00670","PR ANESTH,EXTENSIVE SPINE,CORD PROCED"]
["0067T","CT COLONOGRAPHY;DX"]
["0068T","ACOUS HRT SOUND REC&CPTR ALYS W/I&R"]
["0069T","ACOUS HRT SOUND REC&CPTR ALYS ACOUS HRT SOUND"]
["00700","PR ANESTH,ABD WALL,UPER ANTER,SURG"]
["00702","PR ANESTH,FOR LIVER BIOPSY"]
["00702001","HC BETAMETHASONE ACET&SOD PHOSP"]
["0070T","ACOUS HRT SOUND REC&CPTR ALYS I&R ONLY"]
["0071A","ADM SARSCV2 10MCG TRS-SUCR 1 PEDI"]
["0071A001","HC ADM SARSCV2 10MCG TRS-SUCR 1 PEDI"]
["0071T","PR FOCUS US UTERINE LEIOMYOMA ABLATION W MR GUIDE, < 200 CC"]
["0072A","ADM SARSCV2 10MCG TRS-SUCR 2 PEDI"]
["0072A001","HC ADM SARSCV2 10MCG TRS-SUCR 2 PEDI"]
["0072T","PR FOCUS US UTERINE LEIOMYOMA ABLATION W MR GUIDE, >= 200 CC"]
["00730","PR ANESTH,ABD WALL,UPPER POST,SURG"]
["00731","PR ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED PROXIMAL TO DUODENUM; NOT OTHERWISE SPECIFIED"]
["00732","PR ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED PROXIMAL TO DUODENUM; ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)"]
["0073A","ADM SARSCV2 10MCG TRS-SUCR 3"]
["0073A001","HC ADM SARSCV2 10MCG TRS-SUCR 3"]
["0073T","PR COMP BEAM MODULATION TX, 3 OR MORE FIELDS, PER SESSION"]
["00740","PR ANESTH,UGI ENDOSCOPY"]
["0074A","ADM SARSCV2 10MCG TRS-SUCR B"]
["0074A001","HC ADM SARSCV2 10MCG TRS-SUCR B"]
["0074T","ONLINE PHYSICIAN E/M"]
["00750","PR ANESTH,REPAIR UPPER ABD HERNIA NOS"]
["00752","PR ANESTH,REPAIR UP HERNIA LUMBAR/VENTR"]
["00754","PR ANESTH,REPAIR UP HERNIA OMPHALOCELE"]
["00756","PR ANESTH,REPAIR UP HERNIA DIAPHRAGM"]
["0075T","PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL"]
["0075T001","HC EXTRACRANIAL VERTEBRAL ARTERY STENT(S), INITIAL VESSEL"]
["0076T","PR TCAT PLMT XTRC VRT CRTD STENT RS&IPRQ EA VSL"]
["0076T001","HC EXTRACRANIAL VERTEBRAL ARTERY STENT(S), EACH ADDITIONAL VESSEL"]
["00770","PR ANESTH,MAJOR ABD BLOOD VESSEL REPAIR"]
["0077T","CEREB THERM PERFUSION PROBE"]
["0078T","PR AAA REPAIR W/ VISCERAL VESSEL INVOLVE, W/ PROSTHESIS"]
["00790","PR ANESTH,SURG UPPER ABDOMEN"]
["00792","PR ANESTH,PARTIAL LIVER REMOVAL"]
["00794","PR ANESTH,PANCREAS REMOVAL"]
["00796","PR ANESTH,FOR LIVER TRANSPLANT"]
["00797","PR ANESTH,GASTRIC RESTRICT, MORBID OBESITY"]
["0079T","PR AAA REPAIR W/ VISCERAL VESSEL INVOLVE, EA ADD VESSEL"]
["00800","PR ANESTH,ABD WALL,LOWER ANT,SURG"]
["00802","PR ANESTH,FAT LAYER REMOVAL"]
["0080T","PR AAA REPAIR W/ VISCERAL VESSEL INVOLVE, 2-DOCK PROSTH, RAD SUPER"]
["00810","PR ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM 5"]
["00811","PR ANESTHESIA FOR UNSPECIFIED LOWER INTESTINAL ENDOSCOPIC PROCEDURE WHERE THE SURGICAL PROVIDER INTRODUCES AN ENDOSCOPE INTO THE INTESTINES UP TO BUT NOT INTO THE DUODENUM"]
["00812","PR ANESTHESIA FOR A SCREENING COLONOSCOPY DURING WHICH INTRODUCES AN ENDOSCOPE INTO THE INTESTINES BELOW THE DUODENUM"]
["00813","PR ANESTHESIA FOR BOTH UPPER AND LOWER INTESTINAL ENDOSCOPY WHICH INTRODUCES AN ENDOSCOPE INTO THE INTESTINES ABOVE AND BELOW THE DUODENUM"]
["0081A","ADMIN OF SARSCOV-2 PFIZER VACCINES ONLY - 1ST DOSE"]
["0081A001","HC IMMUNIZATION ADMIN OF SARSCOV-2 PFIZER VACCINES ONLY - 1ST DOSE"]
["0081A002","HC ADM SARSCV2 3MCG TRS-SUCR 1ST"]
["0081T","PR AAA REPAIR W/ VISCERAL VESSEL INVOLVE, EA ADD VESSEL, RAD SUPER"]
["00820","PR ANESTH,ABD WALL,LOWER POST,SURG"]
["0082A","ADMIN OF SARSCOV-2 PFIZER VACCINES ONLY - 2ND DOSE"]
["0082A001","HC IMMUNIZATION ADMIN OF SARSCOV-2 PFIZER VACCINES ONLY - 2ND DOSE"]
["0082A002","HC ADM SARSCV2 3MCG TRS-SUCR 2ND"]
["0082T","PR STEREOTACTIC RAD TX DELIVERY"]
["00830","PR ANESTH,REPAIR LO ABD HERNIA NOS"]
["00832","PR ANESTH,REPAIR LO HERNIA VENTR/INCIS"]
["00834","PR ANESTH,REPAIR LO ABD HERNIA NOS, < 1 YR"]
["00836","PR ANESTH,REP LO ABD HERN NOS, PREM <50 WKS"]
["0083A","ADM SARSCV2 3MCG/ TRS-SUCR 3"]
["0083A001","HC ADM SARSCV2 3MCG TRS-SUCR 3"]
["0083T","PR STEREOTACTIC RAD TX MNGMT"]
["00840","PR ANESTH,SURG LOWER ABDOMEN"]
["00842","PR ANESTH,AMNIOCENTESIS"]
["00844","PR ANESTH,ABD-PERINEAL RESECTION"]
["00846","PR ANESTH,RADICAL HYSTERECTOMY"]
["00848","PR ANESTH,PELVIC EXENTERATION"]
["0084T","TEMP PROSTATE URETHRAL STENT"]
["00851","PR ANESTH,TUBAL LIGATION/TRANSECTION"]
["0085T","PR BREATH TEST FOR HEART TRANSPLANT REJECTION"]
["00860","PR ANESTH,SURG LOW ABD,EXTRAPERINTONEAL"]
["00862","PR ANESTH,KIDNEY,PROX URETER SURG"]
["00864","PR ANESTH,REMOVAL OF BLADDER"]
["00865","PR ANESTH,REMOVAL OF PROSTATE"]
["00866","PR ANESTH,REMOVAL OF ADRENAL"]
["00868","PR ANESTH,KIDNEY TRANSPLANT"]
["0086T","L VENTRICLE FILL PRESSURE MEAS, INDIRECT"]
["00870","PR ANESTH,BLADDER STONE SURG"]
["00872","PR ANESTH,KID STONE DESTRUCT+WATER BATH"]
["00873","PR ANESTH,KID STONE DESTRUCT"]
["0087T","SPERM EVAL HYALURONAN BINDING TEST"]
["00880","PR ANESTH,MAJOR LOW ABD VESSEL SURG"]
["00882","PR ANESTH,INFER VENA CAVAL LIGATION"]
["0088T","RF TONGUE BASE VOL REDUXN"]
["0089T","ACTIGRAPHY TESTING, 3-DAY"]
["00902","PR ANESTH,ANORECTAL SURGERY"]
["00904","PR ANESTH,RADICAL PERINEAL SURGERY"]
["00906","PR ANESTH,REMOVAL OF VULVA"]
["00908","PR ANESTH,PERINEAL REMV OF PROSTATE"]
["0090T","CERVICAL ARTHOPLASTY/ ARTIFIC DISC, SINGLE"]
["00910","PR ANESTH,TRANSURETHRAL SURG,NOS"]
["00912","PR ANESTH,XURETHRAL BLADDER TUMOR SURG"]
["00914","PR ANESTH,XURETHRAL REMOVAL OF PROSTATE"]
["00916","PR ANESTH,POST XURETHRAL BLEEDING CONTR"]
["00918","PR ANESTH,STONE RMVOVAL"]
["0091A","ADM SARSCOV2 50 MCG/.5 ML1ST"]
["0091A001","HC ADM SARSCOV2 50 MCG/.5 ML 1ST"]
["0091T","PR LUMBAR ARTHOPLASTY/ ARTIFIC DISC, SINGLE"]
["00920","PR ANESTH,MALE GENITALIA SURGERY"]
["00921","PR ANESTH,VASECTOMY, UNILAT/BILAT"]
["00922","PR ANESTH,SPERM DUCT SURGERY"]
["00924","PR ANESTH,TESTIS EXPLORATION"]
["00926","PR ANESTH,RADICAL REMV TESTIS,INGUINAL"]
["00928","PR ANESTH,RADICAL REMV TESTIS,ABDOMINAL"]
["0092A","ADM SARSCOV2 50 MCG/.5 ML2ND"]
["0092A001","HC ADM SARSCOV2 50 MCG/.5 ML 2ND"]
["0092T","PR TOTAL DISC ARTHROPLASTY, CERVICAL, EA ADD"]
["00930","PR ANESTH,TESTIS SUSPENSION"]
["00932","PR ANESTH,AMPUTATION OF PENIS"]
["00934","PR ANESTH,PENIS,NODES REMOVAL"]
["00936","PR ANESTH,PENIS,COMBO NODES REMOVAL"]
["00938","PR ANESTH,INSERT PENIS PROSTHESIS"]
["0093A","ADM SARSCOV2 50 MCG/.5 ML3RD"]
["0093A001","HC ADM SARSCOV2 50 MCG/.5 ML 3RD"]
["0093T","REMOVAL TOTAL DISC ARTHROPLASTY,CERVICAL, SINGLE"]
["00940","PR ANESTH,VAGINAL PROCEDURES"]
["00942","PR ANESTH,COLPOT,VAGINECT,COLPORR,URETH PRO"]
["00944","PR ANESTH,VAGINAL HYSTERECTOMY"]
["00948","PR ANESTH,REPAIR OF CERVIX"]
["0094A","ADMIN IM (SARS-COV-2)VACCINE, MODERNA, 50 MCG/0.5 ML DOSAGE, BOOSTER DOSE"]
["0094A001","HC IMMUNIZATION ADMIN IM (SARS-COV-2) VACCINE, MODERNA, 50 MCG/0.5 ML DOSAGE, BOOSTER DOSE"]
["0094T","PR REMOVAL TOTAL DISC ARTHROPLASTY, LUMBAR, SINGLE"]
["00950","PR ANESTH,VAGINAL ENDOSCOPY"]
["00950001","HC ANESTHESIA/VAGINAL ENDOSCOPY"]
["00952","PR ANESTH,HYSTEROSCOPY/VAG BX"]
["00952001","HC ANESTHESIA / HYSTEROSCOPY / VAGINAL BX"]
["0095T","PR REMOVE TOTAL DISC ARTHROPLASTY, CERVICAL, EA ADD"]
["0096T","REVISE TOTAL DISC ARTHROPLASTY,CERVICAL, SINGLE"]
["0097T","PR REVISE TOTAL DISC ARTHROPLASTY, LUMBAR, SINGLE"]
["0098T","PR REVISION TOTAL DISC ARTHROPLASTY, CERVICAL, EA ADD"]
["00999001","HC UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT"]
["0099T","PR IMPLANTATION OF INTRASTROMAL CORNEAL RING SEGMENTS"]
["01001001","HC CDSM EVICORE AUC"]
["01002001","HC CDSM MEDCURRENT AUC"]
["01003001","HC CDSM MEDICALIS AUC"]
["01004001","HC CDSM NATIONAL DECISION SUPPORT COM, AUC"]
["01005001","HC CDSM NATIONAL IMAGINING ASSOCIATES AUC"]
["01006001","HC CDSM TEST APHCOPRIATE AUC"]
["01007001","HC CDSM AIM SPECIALITY HEALTH AUC"]
["01008001","HC CDSM CRANBERRY PEAK AUC"]
["01009001","HC CDSM SAGE HEALTH MANAGEMENT SOLUTION AUC"]
["0100T","PR PLACE SUBCONJ RETINA PROSTHESIS, IMPLANT RETINA ELECTRODE"]
["01010001","HC CDSM STANSON AUC"]
["01011001","HC CDSM QUALIFIED TOOL NOS, AUC"]
["0101T","PR ESW MUSCSKEL SYS NOS"]
["0101TA","PR EPAT THERAPY, INITIAL TREATMENT"]
["0101TB","PR EPAT THERAPY, ADDITIONAL TREATMENT"]
["0101TC","PR EPAT THERAPY, ADDITIONAL TREATMENT,3RD & 4TH VISIT"]
["0102T","PR ESW PHY ANES LAT HMRL EPCNDL"]
["0103T","PR HOLOTRANSCOBALAMIN, QUANTITATIVE"]
["0104T","GAS REBREATHE CARDIAC OUTPUT MEAS, REST"]
["0105T","GAS REBREATHE CARDIAC OUTPUT MEAS, EXERCISE"]
["0106T","PR QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI"]
["0106T001","HC QUANT SENSORY TEST, PER EXTREMITY, TOUCH STIMULI"]
["01073001","HC ROM RAD THERAPY ANAL, TC"]
["01075001","HC ROM RAD THERAPY BLADDER, TC"]
["01077001","HC ROM RAD THER BONE METS, TC"]
["01079001","HC ROM RAD THER BRAIN METS, TC"]
["0107T","PR QUANT SENSORY TEST, PER EXTREMITY, VIBRATION STIMULI"]
["01081001","HC ROM RAD THERAPY BREAST, TC"]
["01083001","HC ROM RAD THERAPY CERVICAL, TC"]
["01085001","HC ROM RAD THERAPY CNS, TC"]
["01087001","HC ROM RAD THER COLORECTAL, TC"]
["01089001","HC ROM RAD THER HEAD/NECK, TC"]
["0108T","PR QUANT SENSORY TEST, PER EXTREMITY, COOLING STIMULI"]
["01095001","HC ROM RAD THERAPY LUNG, TC"]
["01097001","HC ROM RAD THERAPY LYMPHOMA, TC"]
["01099001","HC ROM RAD THERAPY PANCREAS, TC"]
["0109T","PR QUANT SENSORY TEST, PER EXTREMITY, HEAT-PAIN STIMULI"]
["01101001","HC ROM RAD THERAPY PROSTATE, TC"]
["01103001","HC ROM RAD THERAPY GI, TC"]
["01105001","HC ROM RAD THERAPY UTERUS, TC"]
["0110T","PR QUANT SENSORY TEST, PER EXTREMITY, OTHER STIMULI"]
["01110001","HC PROPHYLAXIS-ADULT 14+"]
["01112","PR ANESTH,BONE MARROW ASP/BX ILIAC CRST"]
["0111A","ADM SARSCOV2 25MCG/0.25ML1ST"]
["0111A001","HC ADM SARSCOV2 25MCG/0.25 ML 1ST"]
["0111T","PR LONG-CHAIN OMEGA-3 FATTY ACIDS RBC MEMBRANE"]
["01120","PR ANESTH,BONY PELVIS SURGERY"]
["01120001","HC PROPHYLAXIS UNDER AGE 14"]
["0112A","ADM SARSCOV2 25MCG/0.25ML2ND"]
["0112A001","HC ADM SARSCOV2 25MCG/0.25ML 2ND"]
["01130","PR ANESTH,BODY CAST PROCEDURE"]
["0113A","ADM SARSCOV2 25MCG/0.25ML3RD"]
["0113A001","HC ADM SARSCOV2 25MCG/0.25ML 3RD"]
["01140","PR ANESTH,AMPUTATION AT PELVIS"]
["01145001","HC MFN DRUG ADD-ON, PER DOSE"]
["01150","PR ANESTH,RADICAL PELVIC TUMOR SURGERY"]
["0115T","MED MANAGEMNT, PHARMACIST, INIT, 1ST 15 MIN"]
["01160","PR ANESTH,PUBIS,SACROILIAC OPEN PROC"]
["0116T","MED MANAGEMNT, PHARMACIST, SUBSQNT, 1ST 15 MIN"]
["01170","PR ANESTH,PUBIS,SACROILIAC CLOSED PROC"]
["01173","PR ANESTH, FX REPAIR, PELVIS"]
["0117T","MED MANAGEMNT, PHARMACIST, EA ADD 15 MIN"]
["01180","PR ANESTH,PELV NERV REMOVAL EXTRAPELV"]
["01190","PR ANESTH,PELV NERV REMOVAL INTRAPELV"]
["01200","PR ANESTH,HIP JOINT PROCEDURE"]
["01202","PR ANESTH,ARTHROSCOPY OF HIP"]
["01206001","HC FLUORIDE VARNISH"]
["01208001","HC TOPICAL APP OF FLUORIDE"]
["0120T","PR CRYOABLATE FIBROADENOMA, EACH"]
["01210","PR ANESTH,HIP JOINT SURGERY"]
["01212","PR ANESTH,HIP DISARTICULATION"]
["01214","PR ANESTH,TOTAL HIP ARTHROPLASTY"]
["01215","PR ANESTH,REVISE TOTAL HIP ARTHROPLASTY"]
["0121A","PR ADM SARSCOV2 BIVALENT 30 MCG/0.3 ML 1 DOSE"]
["0121A001","HC ADM SARSCOV2 BIVALENT 30 MCG/0.3 ML 1 DOSE"]
["01220","PR ANESTH,CLOSED PROC UPPER 2/3 FEMUR"]
["01230","PR ANESTH,OPEN PROC UPPER 2/3 FEMUR"]
["01232","PR ANESTH,AMPUTATION OF FEMUR"]
["01234","PR ANESTH,RADICAL FEMUR SURG"]
["0123T","PR FISTULIZATION SCERA FOR GLAUCOMA THRU CILIARY BODY"]
["0124A","ADM SARSCV2 VAC BVL 30MCG/.3ML A"]
["0124A001","HC ADM SARSCV2 BVL 30MCG/.3ML A"]
["0124T","PR INCISE CONJUNCT W POST EXTRASCLERAL PLACEMENT PHARM AGENT"]
["01250","PR ANESTH,UPPER LEG SURGERY"]
["01260","PR ANESTH,UPPER LEG VEINS SURG"]
["01260000","HC COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS"]
["0126T","PR COMMON CAROTID INTIMA-MEDIA THICK FOR AHD/CHD RISK ASSESS"]
["01270","PR ANESTH,THIGH ARTERIES SURG"]
["01272","PR ANESTH,FEMORAL ARTERY LIGATION"]
["01274","PR ANESTH,FEMORAL EMBOLECTOMY"]
["0130T","SINGLE PT, CHRON CARE DRUG INVESTIGATION"]
["01320","PR ANESTH,KNEE AREA SURGERY"]
["01330001","HC ORAL HYGIENE INSTRUCT"]
["0133T","ESOPHAGEAL IMPLANT INJECTION VIA EGD"]
["01340","PR ANESTH,LOWER 1/3 FEMUR,CLOSED PROC"]
["0134A","ADM SARSCOV2 BVL 50MCG/.5ML A"]
["0134A001","HC ADM SARSCV2 BVL 50MCG/.5ML A"]
["01351001","HC SEALANT PER TOOTH"]
["0135T","PERCUTAN CRYOABLATION, RENAL TUMOR"]
["01360","PR ANESTH,LOWER 1/3 FEMUR,OPEN PROC"]
["0137T","PROSTATE BIOPSY, NEEDLE, SATURATION SAMPLING"]
["01380","PR ANESTH,KNEE JOINT,CLOSED PROCEDURE"]
["01382","PR ANESTH,DX ARTHROSCOPIC PROC KNEE JOINT"]
["01390","PR ANESTH,UPPER LEG,CLOSED PROCEDURE"]
["01392","PR ANESTH,UPPER LEG,OPEN PROCEDURE"]
["01400","PR ANESTH,KNEE JOINT; NOS"]
["01402","PR ANESTH,TOTAL KNEE ARTHROPLASTY"]
["01404","PR ANESTH,AMPUTATION AT KNEE"]
["0140T","EXHALED BREATH CONDENSATE PH"]
["0141A","PR ADM SARSCOV2 BIVALENT 25 MCG/0.25 ML 1ST"]
["0141A001","HC ADM SARSCOV2 BIVALENT 25 MCG/0.25 ML 1ST"]
["0141T","PR PANCREATIC ISLET CELL TRANSPLANT, THRU PORTAL VEIN, PERCUTAN"]
["01420","PR ANESTH,KNEE JOINT CASTING"]
["0142A","PR ADM SARSCOV2 BIVALENT 25 MCG/0.25 ML 2ND"]
["0142A001","HC ADM SARSCOV2 BIVALENT 25 MCG/0.25 ML 2ND"]
["0142T","PR PANCREATIC ISLET CELL TRANSPLANT, THRU PORTAL VEIN, OPEN"]
["01430","PR ANESTH,KNEE VEINS SURGERY"]
["01432","PR ANESTH,KNEE AV FISTULA VESSEL SURG"]
["0143T","PR PANCREATIC ISLET CELL TRANSPLANT, THRU PORTAL VEIN, LAP"]
["01440","PR ANESTH,KNEE ARTERIES SURG"]
["01442","PR ANESTH,POPLIT THROMBOENDARTECTOMY"]
["01444","PR ANESTH,POPLIT ARTERY EXCISION"]
["0144A","ADM SARSC2 BVL 25MCG/.25ML A"]
["0144A001","HC ADM SRSCV2 BVL 25MCG/.25 ML A"]
["0144T","CT HEART W/O DYE; CORONARY CA QUANT"]
["0145T","CT HEART W/WO DYE; STRUCT MORPH"]
["01462","PR ANESTH,LOWER LEG,CLOSED PROCEDURE"]
["01464","PR ANESTH,ARTHROSCOP PROC,ANKLE &/OR FOOT"]
["0146T","CT HEART W/WO DYE, CT ANGIO, W/O QUAN EVAL CALCIUM"]
["01470","PR ANESTH,LOWER LEG,OPEN SURGERY"]
["01472","PR ANESTH,ACHILLES TENDON SURG"]
["01474","PR ANESTH,GASTROCNEMIUS SURGERY"]
["0147T","CT HEART W/WO DYE, CT ANGIO, W/ QUAN EVAL CALCIUM"]
["01480","PR ANESTH,LOWER LEG BONE SURG"]
["01482","PR ANESTH,RADICAL LEG RESECTION"]
["01484","PR ANESTH,LOWER LEG BONE REVISION"]
["01486","PR ANESTH,ANKLE REPLACEMENT"]
["0148T","CT HEART W/WO DYE, STRUCT; CT ANGIO, W/O QUAN EVAL CALCIUM"]
["01490","PR ANESTH,LOWER LEG CASTING"]
["0149T","CT HEART W/WO DYE, STRUCT; CT ANGIO, W/ QUAN EVAL CALCIUM"]
["01500","PR ANESTH,LOWER LEG ARTERIES SURG"]
["01502","PR ANESTH,LOWER LEG EMBOLECTOMY"]
["0150T","CT HEART W/WO DYE, STRUCT, CONG HRT DZ"]
["01510001","HC SPACE MAINT-FIXED UNI"]
["01515001","HC SPACE MAINT-FIXED BILAT"]
["01516001","HC SPACE MAINTAINER – FIXED – BILATERAL, MAXILLARY"]
["01517001","HC SPACE MAINTAINER – FIXED – BILATERAL, MANDIBULAR"]
["0151A","PR ADM SARSCOV2 BIVALENT 10 MCG/0.2 ML 1ST"]
["0151A001","HC ADM SARSCOV2 BIVALENT 10 MCG/0.2 ML 1ST"]
["0151T","CT HEART W/WO DYE,  FUNCTION EVALUATION"]
["01520","PR ANESTH,LOWER LEG VEIN SURG,NOS"]
["01522","PR ANESTH,LOWER LEG VEIN THROMBECTOMY"]
["01525001","HC SPACE MAINT-REMOV-BILAT"]
["0153T","TRANSCATH PLACE SENSOR ANEURYSM SAC"]
["0154A","ADM SARSCV2 BVL 10MCG/.2ML A"]
["0154A001","HC ADM SARSCV2 BVL 10MCG/.2ML A"]
["0154T","STUDY SENSOR ANEURYSM SAC"]
["0155T","PR IMPLANT/ REPLACE GASTRIC STIM ELECTRODE,LESS CURVE, LAP"]
["0156T","PR REVISE/ REMOVE GASTRIC STIM ELECTRODE,LESS CURVE, LAP"]
["01575001","HC DISTAL SHOE SPACE MAINTAINER – FIXED – UNILATERAL"]
["0157T","PR IMPLANT/ REPLACE GASTRIC STIM ELECTRODE,LESS CURVE, OPEN"]
["0158T","PR REVISE/ REMOVE GASTRIC STIM ELECTRODE,LESS CURVE, OPEN"]
["01590000","HC COMPUTER AIDED DETECTION BREAST MRI"]
["01590001","HC COMPUTER AIDED DETECTION BREAST MRI"]
["0159T","PR BREAST MRI, COMPUTER AIDED DETECTION"]
["0159T000","HC BREAST MRI, COMPUTER AIDED DECTECTION"]
["0160T","TRANSCRANIAL MAGNETIC STIM TREATMENT PLAN"]
["01610","PR ANESTH,SURGERY OF SHOULDER"]
["0161T","TRANSCRANIAL MAGNETIC STIM TREATMENT DELIV, EACH"]
["01620","PR ANESTH,SHOULDER,CLOSED PROCEDURE"]
["01622","PR ANESTH,DX ARTHROSC PROC,SHOULDER JOINT"]
["0162T","ANALYSYS/ PROGRAM GASTRIC NEUROSTIM"]
["01630","PR ANESTH,SHOULDER JOINT,NOS"]
["01632","PR ANESTH,RADICAL SURG SHOULDER BONES"]
["01634","PR ANESTH,SHOULDER JOINT AMPUT"]
["01636","PR ANESTH,FOREQUARTER AMPUT"]
["01638","PR ANESTH,SHOULDER REPLACEMENT"]
["0163T","PR TOTAL DISC ARTHROPLASTY, LUMBAR, EA ADD"]
["0164A","ADM SRSCV2 BVL 10MCG/0.2ML ADL MODERNA"]
["0164A001","HC ADM SRSCV2 BVL 10MCG/0.2ML ADL MODERNA"]
["0164T","PR REMOVE TOTAL DISC ARTHROPLASTY, LUMBAR, EA ADD"]
["01650","PR ANESTH,SHOULDER ARTERY SURG,NOS"]
["01652","PR ANESTH,AXILLARY-BRACHIAL ANEURYSM"]
["01654","PR ANESTH,SHLDR VESSEL SURG,BYPASS GRFT"]
["01656","PR ANESTH,AXILL-FEM BYPASS GRFT SURG"]
["0165T","PR REVISION TOTAL DISC ARTHROPLASTY, LUMBAR, EA ADD"]
["0166T","PR TRANSMYOCARDIAL CLOSURE VSD, W IMPLANT, WO BYPASS"]
["01670","PR ANESTH,SHOULDER VEIN SURG"]
["0167T","PR TRANSMYOCARDIAL CLOSURE VSD, W IMPLANT, W BYPASS"]
["01680","PR ANESTH,SHOULDER CASTING"]
["01682","PR ANESTH,SHOULDER SPICA"]
["0168T","PR RHINOPHOTOTHERAPY LIGHT APPLICATION BILATERAL"]
["0169T","PR STEROTACTIC BRAIN INFUSION CATHETER PLACEMENT"]
["0170T","REPAIR OF ANORECTAL FISTULA W/ PLUG"]
["01710","PR ANESTH,ELBOW AREA SURGERY"]
["01712","PR ANESTH,UPPERARM TENDON SURG"]
["01714","PR ANESTH,UPPERARM TENDON REVISN SURG"]
["01716","PR ANESTH,BICEPS TENDON REPAIR"]
["01717001","HC BRACHYTHERAPY SOURCE"]
["0171A","PR ADM SARSCOV2 BIVALENT 3 MCG/0.2 ML 1ST"]
["0171A001","HC ADM SARSCOV2 BIVALENT 3 MCG/0.2 ML 1ST"]
["0171T","PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, SINGLE"]
["0172A","PR ADM SARSCOV2 BIVALENT 3 MCG/0.2 ML 2ND"]
["0172A001","HC ADM SARSCOV2 BIVALENT 3 MCG/0.2 ML 2ND"]
["0172T","PR INSERT POST SPINOUS PROCESS DISTRACTION DEVICE, LUMBAR, EA ADD"]
["01730","PR ANESTH,ARM/ELBOW BONES,CLOSED PROC"]
["01732","PR ANESTH,DX ARTHROSCOPIC PROC ELBOW JOINT"]
["0173A","ADM SARSCV2 BVL 3MCG/0.2ML 3RD PFIZER"]
["0173A001","HC ADM SARSCV2 BVL 3MCG/0.2ML 3RD PFIZER"]
["0173T","PR MONITOR INTRAOCULAR PRESSURE DURING VITRECTOMY"]
["01740","PR ANESTH,ELBOW,NOS"]
["01742","PR ANESTH,HUMERUS SURGERY"]
["01744","PR ANESTH,HUMERUS REPAIR"]
["0174A","IMM ADMN SARSCOV2 BIVALET 3 MCG/0.2 ML ADL DOSE"]
["0174A001","HC IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML ADL DOSE"]
["0174T","PR CAD CHEST RADIOGRAPH W PRIMARY INTERPRET"]
["01756","PR ANESTH,RADICAL HUMERUS SURG"]
["01758","PR ANESTH,HUMERAL LESION SURG"]
["0175T","PR CAD CHEST RADIOGRAPH REMOTE FROM PRIMARY INTERPRET"]
["01760","PR ANESTH,ELBOW REPLACEMENT"]
["0176T","PR AQUEOUS CANAL TRLUML DILAT W/O STENT RETENTION"]
["01770","PR ANESTH,UPPERARM ARTERY SURG"]
["01772","PR ANESTH,UPPERARM EMBOLECTOMY"]
["0177T","PR AQUEOUS CANAL TRLUML DILAT W STENT RETENTION"]
["01780","PR ANESTH,UPPER ARM VEIN SURG"]
["01782","PR ANESTH,UPPER ARM VEIN REPAIR"]
["0178T","PR 64+ LEAD ECG W INTERPRETATION & REPORT"]
["0179T","PR 64+ LEAD ECG W TRACING & GRAPHICS"]
["0180T","PR 64+ LEAD ECG W INTERPRETATION & REPORT ONLY"]
["01810","PR ANESTH,LOWER ARM SURGERY"]
["0181T","PR CORNEAL HYSTERESIS, AIR IMPULSE, BILATERAL"]
["01820","PR ANESTH,FOREARM BONES,CLOSED PROC"]
["01829","PR ANESTH,DX ARTHROSCOPIC PROC WRIST"]
["0182T","PR HIGH DOSE RATE ELECTRONIC BRACHYTHERAPY, PER FRACTION"]
["01830","PR ANESTH,DISTAL RADIUS/ULNA WRIST/HAND,NOS"]
["01832","PR ANESTH,WRIST REPLACEMENT"]
["0183T","PR LOW FREQUENCY WOUND ULTRASOUND, PER DAY"]
["01840","PR ANESTH,LOWER ARM ARTERY SURG"]
["01842","PR ANESTH,LOWER ARM EMBOLECTOMY"]
["01844","PR ANESTH,LOWER ARM,VASC SHUNT SURG"]
["0184T","PR RECTAL TUMOR EXCISION, TRANSANAL ENDOSCOPIC MICROSURGICAL, FULL THICK"]
["01850","PR ANESTH,LOWER ARM VEIN SURG"]
["01852","PR ANESTH,LOWER ARM VEIN REPAIR"]
["0185T","PR MULTIVARIATE ANALYSIS PT FINDINGS W COMPUTER PROBABILITY"]
["01860","PR ANESTH,LOWER ARM CASTING"]
["0186T","PR SUPRACHOROIDAL PHARMACOLOGIC AGENT DELIVERY"]
["0187T","PR SCAN COMPUTER OPHTHO IMAGE, ANT SEGMENT, W INTERP/REPORT, UNILAT"]
["0188T","PR VIDEOCONFERENCED CRITICAL CARE, FIRST 30- 74 MIN"]
["0189T","PR VIDEOCONFERENCED CRITICAL CARE, EA ADDL 30 MIN"]
["01905","PR ANESTH, MYELOGRAPHY, DISCOGRAPHY, VERTEBROPLASTY"]
["0190T","PR INTRAOCULAR RADIATION SRC APPLICATOR PLACEMENT"]
["01910001","HC INSERT ANT SEGMENT DRAIN INT"]
["01916","PR ANESTH,DX ARTERIOGRAPHY/VENOGRAPHY"]
["0191T","PR ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT"]
["01920","PR ANESTH,CARDIAC CATH W/CORON ART & VENT"]
["01922","PR ANESTH,CAT/MRI SCAN,RADIATN THERAPY"]
["01924","PR ANESTH,INTER RAD,ARTERIAL SYS,NOS"]
["01925","PR ANESTH,INTER RAD, ARTERIAL, CAROTID/CORONARY"]
["01926","PR ANESTH,INTER RAD,ARTERIAL, INTRACRA/INTRACAR/AORT"]
["0192T","PR INSERT ANT SEGMENT DRAIN WO RESERVOIR, EXTERNAL APPROACH"]
["01930","PR ANESTH,INTER RAD,VENOUS/LYMPH SYS,NOS"]
["01931","PR ANESTH,INTER RAD,VENOUS/LYMPH,INTRAHEPAT/PORTAL CIRC"]
["01932","PR ANESTH,INTER RAD,VENOUS/LYMPH,INTRATHORACIC/JUGULAR"]
["01933","PR ANESTH,INTER RAD,VENOUS/LYMPH,INTRACRANIAL"]
["01935","PR ANESTH,PERC IMAGE GUIDE SPINAL PROC, DIAG"]
["01936","PR ANESTHESIA FOR PERCUTANEOUS IMAGE GUIDED PROCEDURES ON THE SPINE AND SPINAL CORD; THERAPEUTIC"]
["01937","PR ANESTHESIA FOR PERCUTANEOUS IMAGE-GUIDED INJECTION, DRAINAGE OR ASPIRATION PROCEDURES ON THE SPINE OR SPINAL CORD; CERVICAL OR THORACIC"]
["01938","PR ANESTHESIA FOR PERCUTANEOUS IMAGE-GUIDED INJECTION, DRAINAGE OR ASPIRATION PROCEDURES ON THE SPINE OR SPINAL CORD; LUMBAR OR SACRAL"]
["01939","PR ANESTHESIA FOR PERCUTANEOUS IMAGE-GUIDED DESTRUCTION PROCEDURES BY NEUROLYTIC AGENT ON THE SPINE OR SPINAL CORD; CERVICAL OR THORACIC"]
["0193T","PR TRANSURETHRAL RF BLADDER NECK MICROREMODEL"]
["01940","PR ANESTHESIA FOR PERCUTANEOUS IMAGE-GUIDED DESTRUCTION PROCEDURES BY NEUROLYTIC AGENT ON THE SPINE OR SPINAL CORD; LUMBAR OR SACRA"]
["01941","PR ANESTHESIA FOR PERCUTANEOUS IMAGE-GUIDED NEUROMODULATION OR INTRAVERTEBRAL PROCEDURES (EG, KYPHOPLASTY, VERTEBROPLASTY) ON THE SPINE OR SPINAL CORD; CERVICAL OR THORACIC"]
["01942","PR ANESTHESIA FOR PERCUTANEOUS IMAGE-GUIDED NEUROMODULATION OR INTRAVERTEBRAL PROCEDURES (EG, KYPHOPLASTY, VERTEBROPLASTY) ON THE SPINE OR SPINAL CORD; LUMBAR OR SACRAL"]
["0194T","PR PROCALCITONIN"]
["01951","PR ANESTH,BURN TX, <4% TBSA"]
["01952","PR ANESTH,BURN TX, 4-9% TBSA"]
["01953","PR ANESTH,BURN TX, EACH ADDITIONAL 9% TBSA"]
["01958","PR ANESTH, ANTEPARTUM MANIPUL"]
["0195T","PR ARTHRODESIS PRESACRAL INTERBODY"]
["01960","PR ANESTH,VAGINAL DELIVERY ONLY"]
["01961","PR ANESTH,CESAREAN DELIVERY ONLY"]
["01962","PR ANESTH,URG HYSTERECTOMY FOL DELIVERY"]
["01963","PR ANESTH,CESAREAN HYST W/O LABOR ANAL/ANES"]
["01964","PR ANESTH,ABORTION PROC"]
["01965","PR ANESTH, INCOMP/MISSED AB PROC"]
["01966","PR ANESTH, INDUCED AB PROCEDURE"]
["01967","PR ANESTH, NEURAXIAL LABOR, PLAN VAG DEL"]
["01968","PR ANESTH,CES DEL AFTER NEURAXIAL ANESTH"]
["01969","PR ANESTH,CES HYST FOL NEURAXIAL ANAL/ANES"]
["0196T","PR ARTHRODESIS PRESACRAL INTERBODY EA INTERSPACE"]
["0197T","PR INTRA-FRACT LOCAL/TRACK TARGET/PT DURING DELIVERY RADIATION TX"]
["0198T","PR MEAS OCULAR BLOOD FLOW BY REPETITIVE INTRAOCULAR PRESSURE SAMPLE"]
["01990","PR PHYS SUPPORT,BRAIN-DEAD ORGAN DONOR"]
["01991","PR ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS"]
["01992","PR ANES DX/THER NERVE BLOCK/INJECTION PRONE POS"]
["01995","PR REGION IV LOCAL ANESTH,UPPER/LOWER EXT"]
["01996","PR DAILY MGMT,EPIDUR/SUBARACH CONT DRUG ADM"]
["01996001","HC DAILY MGMT,EPIDUR/SUBARACH CONT DRUG ADM"]
["01999","PR UNLISTED ANESTH PROCEDURE"]
["0199T","PR PHYSIOLOGIC RECORD TREMOR W ACCELEROMETER/GYROSCOPE"]
["0200T","PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL"]
["02011001","HC ALCOHOL/SUB ABUSE ASSESS"]
["02012001","HC BRIEF CHECK IN BY MD/QHP"]
["02016002","HC COMP COMM SUPP SVC, PER DIEM-HOMELESS INDIVIDUALS"]
["02016003","HC COMP COMM SUPP SVC, PER-DIEM- JUSTICE INVOLVED"]
["02016004","HC COMP COMM SUPP SVC, PER DIEM- TENANCY PRESERVATION"]
["0201T","PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS"]
["02023001","HC SPECIMEN COLLECTION FOR  CORONAVIRUS"]
["02024001","HC SPECIMEN COLLECTION FOR CORONAVIRUS; LAB BEHALF OF HHA"]
["0202T","PR POST VERT ARTHROPLASTY W/WO BONE CEMENT, 1 LUMBAR LEVEL"]
["0202U","NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2"]
["0202U000","HC NFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2"]
["02038001","HC COMM TRANS WAIVER/SERVICE"]
["0203T","PR SLEEP STUDY, UNATTEND, SIMULTAN RECORD HR/O2 SAT/RESP/SLEEP TIME"]
["0204T","PR SLEEP STUDY, UNATTEND, SIMULT RECORD HR,O2 SAT,RESP, OR SLEEP TIME"]
["02050001","HC FINANCIAL MGT WAIVER/DIEM"]
["0205T","PR INTRAVASC CATH CORONARY/GRAFT SPECTROSCOPY DURING OTHER PROC, EA VES"]
["02066001","HC INTERROGATION EVAL REMOTE </30 D TECH"]
["0206T","PR RMT ALGRTHMC ALYS ECG W/CPTR PRBLTY ASSMT"]
["0207T","PR EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL"]
["0207T001","HC EVAC MEIBOMIAN GLANDS, AUTO, HEAT/INTERMIT PRESSURE, UNILATERAL"]
["02083001","HC ADJUSTMENT GASTRIC BAND"]
["02086001","HC OFF BASE OPIOID TX 70MIN"]
["02087001","HC OFF BASE OPIOID TX, 60 M"]
["02088001","HC OFF BASE OPIOID TX, ADD30"]
["0208T","PR PURE TONE AUDIOMETRY, AIR ONLY, AUTOMATED"]
["0209T","PR PURE TONE AUDIOMETRY, AIR AND BONE, AUTOMATED"]
["0210T","PR SPEECH AUDIOMETRY THRESHOLD AUTOMATED"]
["0211T","PR SPEECH AUDIOMETRY THRESHOLD AUTOMATED WITH SPEECH RECOGNITION"]
["0212T","PR COMPREHENSIVE AUDIOMETRY THRESHOLD AND SPEECH RECOGNITION, AUTOMATED"]
["0213T","PR INJ DX/THER AGNT PARAVERT FACET JOINT,U/S GUIDE,CERV/THORAC, 1ST LEVEL"]
["02140001","HC AMALGAM 1 SURFACE"]
["0214T","PR INJ DX/THER AGNT PARAVERT FACET JOINT,U/S GUIDE,CERV/THORAC, 2ND LEVEL"]
["02150001","HC AMALGAM 2 SURFACE"]
["0215T","PR INJ DX/THER AGNT PARAVERT FACET JOINT,U/S GUIDE,CERV/THORAC, ADD LEVEL"]
["02160001","HC AMALGAM THREE SURFACE"]
["02161001","HC AMALGAM 4+SURF TOOTH"]
["0216T","PR INJ DX/THER AGNT PARAVERT FACET JOINT,U/S GUIDE,LUMBAR/SAC, 1ST LEVEL"]
["0217T","PR INJ DX/THER AGNT PARAVERT FACET JOINT,U/S GUIDE,LUMBAR/SAC, 2ND LEVEL"]
["0218T","PR INJ DX/THER AGNT PARAVERT FACET JOINT,U/S GUIDE,LUMBAR/SAC, ADD LEVEL"]
["0219T","PR PLACE POST INTRAFACET IMPLANT, UNI OR BILAT, INC IMG, 1 LEVEL,CERVICAL"]
["0220001","HC RUGS CODE"]
["0220T","PR PLACE POST INTRAFACET IMPLANT, UNI OR BILAT, INC IMG, 1 LEVEL,THORACIC"]
["02212001","HC PROLONG OUTPT/OFFICE VIS"]
["02215001","HC HOME SUPPLY NASAL NALOXONE"]
["02216001","HC HOME SUPPLY INJECT NALOXON"]
["0221T","PR PLACE POST INTRAFACET IMPLANT, UNI OR BILAT, INC IMG, 1 LEVEL,LUMBAR"]
["0222T","PR PLACE POST INTRAFACET IMPLANT, UNI OR BILAT, INC IMG, EA ADD LEVEL"]
["0223T","PR ACOUSTIC CARDIOGRAPHY W/I&R"]
["0224T","PR ACOUSTIC CARDIOGRAPHY 1+ ALYS W/I&R"]
["0225T","PR ACOUSTIC CARDIOGRAPHY 1+ ALYS W/I&R & REPROG"]
["0226T","PR ANOSCOPY, HIGH RESOLUTION W/ BRUSH/WASH SPECIMEN"]
["02270001","HC RX ASY PRSMV 30+RX/METABLT"]
["0227T","PR ANOSCOPY, HIGH RESOLUTION W/ BIOPSY"]
["02280001","HC ONC PRST8 MA MOLEC PRFL ALG"]
["0228T","PR INJECT ANES/STEROID FORAMEN CERV/THORACIC W U/S GUIDE ,1 LEVEL"]
["02290001","HC BCAT1 PROMOTER MTHYLTN ALYS"]
["0229T","PR INJECT ANES/STEROID FORAMEN CERV/THORACIC W U/S GUIDE ,EA ADD LEVEL"]
["02300001","HC AR FULL SEQUENCE ANALYSIS"]
["0230001","HH SOC"]
["0230002","HH F/U"]
["0230003","HH SCIC"]
["0230004","HH ROC"]
["0230T","PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W U/S GUIDE ,1 LEVEL"]
["02310001","HC CACNA1A FULL GENE ANALYSIS"]
["0231T","PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W U/S GUIDE ,EA ADD LEVEL"]
["02320001","HC CSTB FULL GENE ANALYSIS"]
["0232T","PR INJECT PLATELET RICH PLASMA W/IMG HARVEST/PREPARATOIN/KIT"]
["0232TLG","NJX PLATELET PLASMA LG"]
["02330000","HC FXN GENE ANALYSIS"]
["02330001","HC RESIN 1 SURFACE-ANTERIOR"]
["02331001","HC RESIN 2 SURFACE -ANTERIOR"]
["02332001","HC RESIN 3 SURFACE-ANTERIOR"]
["02335001","HC 4+SURF INCISAL ANGLEANTER"]
["0233T","PR SKIN ADVANCED GLYCATION ENDPRODUCTS SPECTROSCOPY"]
["02340000","HC TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA"]
["02340001","HC MECP2 FULL GENE ANALYSIS"]
["0234T","PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, RENAL ARTERY"]
["02350000","HC TRLUML PERIPHERAL ATHERECTOMY VISCERAL ARTERY EA"]
["02350001","HC PTEN FULL GENE ANALYSIS"]
["0235T","PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, VISCERAL ARTERY, EACH"]
["02360000","HC TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA"]
["02360001","HC SMN1&SMN2 FULL GENE ANALYSIS"]
["0236T","PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, ABDOMINAL AORTA"]
["02370000","HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL"]
["02370001","HC CAR ION CHNLPTHY GEN SEQ PNL"]
["0237T","PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, BRACHIOCEPHAL AND BRANCHES, EACH"]
["02380000","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA"]
["02380001","HC ONC LNCH SYN GEN DNA SEQ ALY"]
["0238T","PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, ILIAC ARTERY, EACH"]
["0238T000","HC TRLUML PERIPHERAL ATHERECTOMY ILIAC ATERY EA"]
["02390000","HC TRGT GEN SEQ ALYS PNL 311+"]
["02390001","HC ANT RESIN COMPOSITE CROWN"]
["02391001","HC POST RESIN COMP - 1 SURF"]
["02392001","HC POST RESIN COMP - 2 SURF"]
["02393001","HC POST RESIN COMP - 3 SURF"]
["02394001","HC POST RESIN COMP - 4+ SURF"]
["0239T","PR BIOIMPEDANCE SPECTROSCOPY LIMB DIFFERENCES"]
["0240T","PR ESOPHAGEAL MOTILITY STUDY, MANOMETRY W 3-D PRESSURE TOPOGRAPHY"]
["02410000","HC NFCT DS VIR RESP RNA 4 TRGT."]
["02410001","HC NFCT DS VIR RESP RNA 4 TRGT"]
["0241T","PR ESOPH MOTILITY STUDY, MANOMETRY W STIMU/PERFUS & 3-D PRESSURE TOPO"]
["0241U","NFCT DS VIR RESP RNA 4 TRGT"]
["0241U000","HC NFCT DS VIR RESP RNA 4 TRGT"]
["0242T","PR GI TRACT TRANSIT AND PRESSURE MEASURE, WIRELESS CAPSULE, INTERP/REPORT"]
["0243T","PR INTERMIT MEASURE WHEEZE RATE FOR BRONCHODIL DIAG EVAL, INTERP/REPORT"]
["0244T","PR CONTIN MEASURE WHEEZE RATE,TX ASSESS/ NOCTURN WHEEZE/COUGH, 3-24 HOURS"]
["0245T","PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 1-2 RIBS"]
["0246T","PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 3-4 RIBS"]
["0247T","PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 5-6 RIBS"]
["0248T","PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 7+ RIBS"]
["0249T","PR LIGATION HEMORRHOID BUNDLE W/US"]
["0250T","PR AIRWAY SIZING & INSERT BRONCHIAL VALVE EA LOBE"]
["0251T","PR BRONCHOSCOPY, W/REMOVAL BRONCHIAL VLAVE, INITIAL LOBE"]
["0252T","PR BRONCHOSCOPY, W/REMOVAL BRONCHIAL VLAVE,EA ADD LOBE"]
["0253T","PR INSERT ANT SGM DRAINAGE DEV W/O RESERVR INT APPR"]
["02544001","HC ONLAY-METALLIC-4 >MORE SU"]
["0254T","PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI"]
["0255T","PR ENDOVASC REPAIR ILIAC ARTERY BIFURCATION W/ENDOPROSTH,UNI,W RAD SUPER"]
["0256T","PR CATH DELIVERED PROSTHETIC AORTIC VALVE, ENDOVASCULAR APPROACH"]
["0257T","PR CATH DELIVERED PROSTHETIC AORTIC VALVE, OPEN THORACIC APPROACH"]
["0258T","PR TRANSTHORACIC EXPOS CATH DELIVERED PROSTH AORTIC VALVE,W/O CARD BYPASS"]
["0259T","PR TRANSTHORACIC EXPOS CATH DELIVERED PROSTH AORTIC VALVE,W CARD BYPASS"]
["0260T","PR TOT BODY SYST HYPOTHER NEONATE AGE 28 DAYS/<"]
["0261T","PR SELECT HEAD HYPOTHER NEONATE AGE 28 DAYS/<"]
["0262T","PR IMPLANT CATH DELIVRD PROSTH PULM VALVE ENDOVASC"]
["0263T","PR AUTO BONE MARRW CELL RX COMPLT BONE MARRW HARVST"]
["0264T","PR AUTO BONE MARRW CELL RX COMP W/O BONE MAR HARVST"]
["0265T","PR BONE MAR HARVST ONLY FOR INTMUSC AUTOLO CELL RX"]
["0266T","PR IM/REPL CARTD SINUS BAROREFLX ACTIV DEV TOT SYST"]
["0267T","PR IM/REPL CARTD SINS BAROREFLX ACTIV DEV LEAD ONLY"]
["0268T","PR IM/REPL CARTD SINS BARREFLX ACT DEV PLS GEN ONLY"]
["0269T","PR REV/REMVL CARTD SINS BARREFLX ACT DEV TOT SYSTEM"]
["0270T","PR REV/REMVL CARTD SINS BARREFLX ACT DEV LEAD ONLY"]
["0271T","PR REV/REM CARTD SINS BARREFLX ACT DEV PLS GEN ONLY"]
["0272T","PR INTRGORTION DEV EVAL CARTD SINS BARREFLX W/I&R"]
["0273T","PR INTROGATION DEV EVAL CARTD SINS BARREFLX W/PRGRM"]
["02740001","HC PORCELAIN/CERAMIC CROWN"]
["0274T","PR PERC LAMINO-/LAMINECTOMY IMAGE GUIDE CERV/THORAC"]
["02750001","HC CROWNS"]
["0275T","PR PERC LAMINO-/LAMINECTOMY INDIR IMAG GUIDE LUMBAR"]
["0276T","PR BRONCHSCPY FLUORO W/BRONCHIAL THERMPLASTY 1 LOBE"]
["0277T","PR BRONCHSCPY FLUORO W/BRNCHIAL THERMPLASTY />2LOBE"]
["02780000","HC TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["0278T","PR TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS"]
["02790001","HC FULLCAST NIGH NOBLE CROWN"]
["0279T","PR CELL ENUMRTION W/IMMUN SELXN & ID FLUID SPECIMN"]
["0280T","PR CELL ENUMRATION W/IMMUN SELXN ID FLUID SPEC I&R"]
["0281T","PR PERC TRANSCTH CLOSR LT ATRIAL APPNDGE IMPLNT S&I"]
["0282T","PR PERC/OPEN IMPLNT NEUROSTIM ELECTRODE SUBQ TRIAL"]
["0283T","PR PERC/OPEN IMPLNT NEUROSTIM ELECTRODE SUBQ PERM"]
["0284T","PR REV/REMVL PG/ELCTRODES IMAGNG ADDN NEW ELCTRODES"]
["0285T","PR ELEC ANLYS IMPLANT SUBQ FIELD STIM PG REPROGRAMM"]
["0286T","PR NEAR INFRARED SPECTROSCPY STUDIES LOW EXT WOUNDS"]
["0287T","PR NEARINFRED GUIDANCE VASC ACES RL TIME DIG VISU"]
["0288T","PR ANSCPY W/DELVRY THERMAL ENERGY MUSCLE ANAL CANAL"]
["0289T","PR CORNEA INCISNS DONOR CORNEA W/LASR KERTPLSTY"]
["0290T","PR CORNEA INCISNS RECIPIENT CORNEA W/LASR KERTPLSTY"]
["0291T","PR INTRAV OPTCL CHERNCE TMGRPHY W/S&I INTL VESL"]
["02920001","HC RECEMENT CROWN"]
["0292T","PR INTRAV OPTCAL COHRNCE TMGRPHY W/S&I ADL VESL"]
["02930001","HC PREFAB STAINLE STEEL PRIM"]
["02931001","HC PREFABSTAINLES CROWNPERM"]
["0293T","PR INS LT ATRL HEMODYN MOTR CMPLETE SYST W/S&I"]
["02940001","HC SEDATIVE FILLING"]
["0294T","PR INS LT ATRL HEMDYN MTR PRSR SENSR LEAD W/S&I"]
["02950001","HC CORE BUILD UP"]
["02952001","HC CAST POST AND CORE"]
["02954001","HC CAST POST&CORE INADD CROW"]
["0295T","PR EXT ECG > 48HR TO 21 DAY RCRD SCAN ANLYS REP R&I"]
["02962001","HC PORCELAIN VENEER"]
["0296T","PR EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD"]
["0297T","PR EXT ECG > 48HR TO 21 DAY SCAN ANALYSIS W/REPORT"]
["0298T","PR EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN"]
["02999001","HC UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT"]
["0299T","PR ESW HI ENERGY W/TOPCAL APP &DRESNG CARE 1ST WND"]
["0300T","PR ESW HI ENERGY W/TOPCAL APP &DRESNG CARE ADL WND"]
["03014001","HC TELEHEALTH FACILITY FEE"]
["0301T","PR DEST/REDUC MALIG BRST TUMR W/US THRMORX GUIDANCE"]
["0302T","PR INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS COMPL"]
["0303T","PR INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS ELTRD"]
["0304T","PR INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS DEVICE"]
["0305T","PR PROGRAM EVAL ICAR ISCHM MNTRNG SYS"]
["0306T","PR INTERROGATION EVAL ICAR ISCHM MNTRNG SYS"]
["0307T","PR RMVL INTRACARDIAC ISCHEMIA MONITORING DEVICE"]
["0308T","PR INSJ OC TLSCP PROSTH RMVL CRYSTALLINE/IO LENS"]
["0309T","PR ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L4/L5"]
["0310T","PR MOTOR FUNCTION MAPPING NAVIGATED TMS TX PLAN"]
["03110001","HC PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)"]
["0311T","PR N-INVAS CAL & ALYS CNTRL ARTL PRESSURE WAVEFORM"]
["03120001","HC PULP CAP - INDIRECT"]
["0312T","PR LAPS IMPLTJ NSTIM ELTRD ARRAY&PLS GEN VAGUS NRV"]
["0313T","PR LAPS REVJ/REPLCMT NSTIM ELTRD ARRAY VAGUS NRV"]
["0314T","PR LAPS RMVL NSTIM ELTRD ARRAY & PLS GEN VAGUS NRV"]
["0315T","PR REMOVAL PULSE GENERATOR VAGUS NERVE"]
["0316T","PR REPLACEMENT PULSE GENERATOR VAGUS NERVE"]
["0317T","PR ELEC ALYS NSTIM PLS GEN VAGUS NRV W/REPRGRMG"]
["0318T","PR REPLACE AORTIC VALVE OPEN TRANSTHORACIC APPROACH"]
["0319T","INSERT SUBQ DEFIB W/ELTRD"]
["0320T","INSERT SUBQ DEFIB ELECTRODE"]
["0321T","INSERT SUBQ DEFIB PLS GEN"]
["03220001","HC THERA PULPOTOMY EXCEL FI"]
["0322T","RMVL SUBQ DEFIB PLS GEN"]
["0323T","RMVL & REPLC SUBQ PLS GEN"]
["0324T","RMVL SUBQ DEFIB ELECTRODE"]
["0325T","REPOS SUBQ DEFIB ELTRD &/GEN"]
["0326T","EPHYS EVAL SUBQ IMPLT DEFIB"]
["0327T","IMPLT SUBQ DEFIB INTEROGAT"]
["0328T","IMPLT SUBQ DEFIB SYS DEV EVL"]
["03620001","HC BHV ID SUPRT ASSMT EA 15 MIN"]
["04273001","HC AUTOGENOUS CONN. TISSUE GRAFT PROC. 1ST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT"]
["0466T","PR INSERTION CHEST WALL RESPIRATORY SENSOR ELECTRODE/ARRAY"]
["05258001","HC HEARING AID, DIGIT, BIN, CIC"]
["0556F","PR PLAN OF CARE TO ACHIEVE LIPID CONTROL DOCUMENTED"]
["0638T","PR CT BREAST W/3D BI C-/C+"]
["0693T","PR COMPRE FUL BDY 3D MTN ALYS"]
["07321001","HC ALV NO EXT 1-3 TEETH"]
["07940001","HC OSTEOPLASTY - FOR ORTHOGNATHIC DEFORMITIES"]
["0860T001","HC NCNTC IFR SPCTRSC SCR PAD"]
["10012","PR FINE NEEDLE ASPIRATION BX W/MR GDN EA ADDL"]
["1008","SELF-PAY TRAVEL 40% DISCOUNT HB"]
["11055001","HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1"]
["11303","PR SHAV SKIN LES >2.1 CM TRUNK,ARM,LEG"]
["11406001","HC EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM"]
["1183F","PR NEUROPSYCHIATRIC SYMPTOMS ABSENT"]
["12 DISK KB","12 DISK KB"]
["13102","PR REP,SKIN,TRUNK,CMPLX,+5 CM/<"]
["136113","BEHAVIORAL HEALTH: DEPRESSION RESOURCE"]
["14350","PR FILLET FINGR/TOE FLAP W PREP"]
["15576","PR FORM SKIN PEDICLE FLAP LID,EAR,NOSE"]
["15774001","HC GFRG AUTOL FAT LIPO EA ADDL"]
["15879","PR SUCT ASSIS LIPECTOMY,LOW EXTREM"]
["1607","DENTAL SELF-PAY 10% DISCOUNT"]
["19000000","HC PUNCTURE ASPIRATION CYST BREAST"]
["19200","PR MASTEC RAD,PEC MUSC/AXILL NODE"]
["19318","PR REDUCTION OF LARGE BREAST"]
["2030","HB CLEARING ACCOUNT INS PMT"]
["20606","PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US"]
["2099","NON-COVERED DENTAL OTHER FREQUENCY ADJ"]
["21060","PR REMV JAW JOINT CARTILAGE"]
["21142","PR RECONST FACE,LEFORT I,2 PIECES"]
["21400","PR CLOSED RX FX ORBIT"]
["21499B","FOREHEAD CONTOURING W/SCALP ADVANCEMENT AND BROWLIFT"]
["21805","PR OPEN RX RIB FRACTURE"]
["22810","PR ARTHRODESIS ANTERIOR SPINAL DEFORMITY 4-7 SEGMENTS"]
["22899C","REMOVAL OF CAGE"]
["23491","PR REINFORCE PROX HUMERUS/HEAD"]
["23802","PR FUSION SHOULDER JOINT W GRAFT"]
["24546","PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W XTN"]
["24675001","HC CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ"]
["2500003","HC RX 250 WO HCPCS"]
["25000132","HC LIQ,EYE;BIMATO .03% 2.5ML"]
["25000177","HC LIQ,EYE;CRESYLAT 25% 15ML"]
["25259","PR MANIPULATE WRIST W/ANESTHES"]
["25415","PR REPAIR NONUNION RADIUS AND ULNA"]
["25600001","HC CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ"]
["26145","PR RAD EXCIS JT LINING,FLEXOR,EACH"]
["26410","PR REPAIR EXTEN TENDON,DORSUM HAND,EA"]
["26742","PR CLOSE RX FINGR ARTICULAR FX,MANIP"]
["26991","PR INCIS/DRAIN PELVIS/HIP,INFECT BURSA"]
["27000101","HC EXP:CASTSUPP;PATELLA TEND"]
["27000142","HC SPLINT;AFO (IP)"]
["2700042","HC GUIDEWIRE,JAGWIRE"]
["2700155","HC SOFT RESTRAINT"]
["2700189","HC 2 PRESSURE CON TUBING"]
["2700302","HC 4X15 FIBERGLASS SPLINT MATERIAL"]
["2700347","HH VACUTAINER HOLDER - LARGE"]
["2700381","HH COBAN 3\""]
["27140","PR OSTEOTOMY & TRANSFER,GREATER TROCHANTER"]
["27200020","HC KIT;MUCOSAL RESECTION"]
["2720012","HC EMG ENDOTRACHIAL TUBE SIZE 8"]
["27200170","HC SPINUS OVERTUBE EGD"]
["2720050","HC BYRD TRIPLE DIL. SHEATH"]
["27220","PR CLOSED RX ACETABULAR FX"]
["27286","PR FUSION HIP JOINT+SUBTROCH OSTEOTOMY"]
["27400024","HC PNEUMATI WALKING BOOT PREFAB"]
["27400070","HC KO;ELAS,W/PADS"]
["27441","PR PLASTY TIBIAL PLATEAU+DEBRIDE"]
["27613001","HC BX LOW LEG SOFT TISSUE,SUPERFICIAL"]
["27691","PR XFER SINGLE DEEP LOW LEG TENDON"]
["27814","PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE"]
["27899D","PR EXCISION, LEG OR ANKLE BURSA"]
["28106","PR REMV OTHR FOOT BENIGN LESN,AUTOGRFT"]
["28415","PR OPEN TREATMENT CALCANEAL FRACTURE"]
["28576","PR PERCUT RX TALOTARSAL DISLOCATION"]
["29445","PR APPLY RIGID LEG CAST"]
["29807001","HC SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION"]
["29877001","HC KNEE SCOPE, SHAVE ARTICULAR CART"]
["3000067","HC ASSAY OF CARBAMAZEPINE TOTAL"]
["3000134","HC CHG LEUKOCYTE (WBC) COUNT"]
["3000297","HC CHG ASSAY OF GASTRIN"]
["3000352","HC CHG HIV-1, DNA, QUANT"]
["3000764","HC CHG BARTONELLA, DNA, AMP PROBE"]
["3000798","HC CHG M.TUBERCULO, DNA, QUANT"]
["3000975","HC ASSAY OF THYROGLOBULIN"]
["3001211","HC ASSAY, BLOOD CATECHOLAMINES"]
["30100","PR INTRANASAL BIOPSY"]
["3020025","HC CHG RHEUMATOID FACTOR TEST"]
["3025F","PR SPIROMETRY TEST RESULTS DEMONSTRATE FEV/FVC <70%"]
["3049F","PR MOST RECENT LDL-C 100-129 MG/DL"]
["30999C","PR ENDOSCOPIC REPAIR OF CHOANAL ATRESIA"]
["31084","PR OBLITER FRONT SINUS+FLAP,BROW INCIS"]
["3138","IME PAYMENT REVERSAL - DEBIT ADJ (HB ONLY)"]
["31552","PR LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS >"]
["31641","PR BRONCHOSCOPY,RX STENOSIS"]
["31899","PR AIRWAYS SURGICAL PROCEDURE UNLISTED"]
["32000023","HC RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I"]
["3200105","HC XR SM BOWEL SERIES"]
["3200150","HC XR PORTAL VENOGRAM WO HEMODYNAMICS"]
["3200253","HC X-RAY PENIS"]
["3220001","HC XR ARTHRO TMJ"]
["3230033","HC ANGIO CAROTD XTL BIL"]
["32652","PR THORACOSCOPY SURG TOT PULM DECORT"]
["32852","PR LUNG TRANSPLANT,SINGL W CP BYPASS"]
["33211001","HC INSERT CARD ELECTRODES DUAL"]
["33235001","HC RMVL TRANSVNS PM ELTRD DUAL LEAD SYS"]
["33273","PR REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB"]
["33478","PR RV OUTFLOW TRACT AUGMENTATN"]
["3354F","PR STAND SCREEN TOOL CLIN SIGNIF DEPRESS SYMPTOMS"]
["33881","PR ENDOVASC TAA REW/O SUBCL"]
["33955","PR ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS"]
["33997","PR RMVL PERQ RIGHT HEART VAD"]
["3400093","HC NM TUMOR LOC SPECT W RP"]
["3410037","HC URINARY BLADDER RETENTION"]
["35021","PR REANEURYSM/GRFT INS,INNOM/SUBCLAV"]
["3513F","PR HEPATITIS B SCREENING DOCUMENTED AS PERFORMED"]
["3520032","HC CT GUIDE NDL PLACEMENT"]
["35558","PR VEIN BYPASS GRAFT,FEM-FEM"]
["35686","PR CREATION DISTAL AV FIST,LOW EXT BYPASS"]
["3610013","HC PLC BREAST NDL WIRE"]
["3610047","HC INJ HIP W ANESTHESIA"]
["3610161","HC NODE IDENTIFICATION"]
["3610206","HC INJ CON ABSCSS"]
["3610240","HC USC URINE CAPACITY MEASURE"]
["3610358","HC OPN INTRVS STENT INIT"]
["36218","PR PLACE CATH ADDN SUBSELEC ART,NECK"]
["36522","PR PHOTOPHERESIS"]
["36581","PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP"]
["36625","PR INSERT CATH,ART,CUTDOWN,SHORTTERM"]
["37205","PR TRANSCATH STENT INIT VESSEL,PERCUT"]
["37225","PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL"]
["37799AE","PR RESECTION AORTOCAVAL MASS WITH RESECTION OF LIVER SEGMENT"]
["38205","PR PROG CELL HARVEST,TRANSPLANT,ALLOGENIC"]
["38382","PR LIGATN THOR DUCT,ABD APPROACH"]
["4015F","PR PERSIST ASTHMA CONTROL MEDICATION RX"]
["40200037","HC ULTRASOUND TRANSRECTAL"]
["40525","PR FULL THICK EXCIS LIP,RECON W FLAP"]
["40806001","HC INCISION OF LIP FOLD"]
["4115F","PR BETA BLOCKER GIVEN W/IN 24 HRS BEFORE SURG INCISION"]
["41599","PR TONGUE AND MOUTH SURG UNLISTED"]
["41850","PR TREATMENT OF GUM LESION"]
["42100","PR BIOPSY PALATE/UVULA"]
["42320","PR DRAIN ABSC-SUBMAX-EXTERNAL"]
["42890","PR PARTIAL REMOVAL OF PHARYNX"]
["43113","PR EXCIS ESOPH,W/THORACOT,W/COLON INTERPOS"]
["43214","PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM"]
["43273","PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC"]
["43320","PR ESOPHAGOGASTRIC CARDIOPLASTY"]
["43499G","ZENKERS DIVERTICULUM ENDOSCOPIC"]
["43840","PR REPAIR PERF DUOD/GAST ULC-WND/INJ"]
["44000012","HC EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC"]
["44238G","PR LAPAROSCOPIC COLOSTOMY REVISION,  COMPLEX"]
["44378","PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING"]
["44799A","DOUBLE BALLOON ENTEROSCOPY"]
["4500003","HC DRAIN HEMATOMA/FLUID"]
["45020","PR DRAINAGE OF DEEP RECTAL ABSCESS"]
["45388001","HC COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES"]
["4553F","PR PT OFFERED ASSISTANCE PLANNING END LIFE ISSUES"]
["46261","PR HEMORRHOIDECTOMY,INT/EXT,2+ COLUMNS/GROUPS W FISSURECTOMY"]
["46700","PR REPAIR ANAL STRICTURE,ADULT"]
["46999","PR ANUS SURGERY PROCEDURE UNLISTED"]
["47379C","LAPAROSCOPIC SEGMENTECTOMY - LIVER"]
["47532000","HC NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS"]
["4800017","HC ECHO CNGNITL ANOM CMPL"]
["4800051","HC EP ABLTN OF VT"]
["49010001","HC EXPLORATORY RETROPERITONEAL"]
["49325001","HC LAP REVISE INTRAPERITONEAL CATHETER"]
["49411000","HC INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT"]
["49659C","LAPAROSCOPY FEMORAL HERNIA REPAIR"]
["5015","SMALL BALANCE WRITE OFF (ACCOUNT)"]
["50545","PR LAP, RADICAL NEPHRECTOMY"]
["50693","PR PLACEMENT URETERAL STENT PRQ WITH PRE-EXISTING NEPHROSTOMY TRACT"]
["50900","PR REPAIR OF URETER"]
["51102001","HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER"]
["51725001","HC SIMPLE CYSTOMETROGRAM"]
["52356001","HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT"]
["53275","PR EXCIS URETHRAL PROLAPSE"]
["53853","PR PROSTATIC WATER-INDUCED THERMOTX"]
["54520","PR REMOVAL TESTIS,SIMPLE"]
["55120","PR REMOVAL OF SCROTAL FOR.BODY"]
["56740","PR EXCIS BARTHOLIN GLAND/CYST"]
["57156001","HC INSERTION OF CYLINDER"]
["57415001","HC REMOVAL VAGINAL FOR.BODY W ANESTH"]
["58540","PR REVISION OF UTERINE ANOMALY"]
["58671","PR LAP,TUBAL BLOCK BY DEVICE"]
["59622","PR C-SEC+POSTPARTUM CARE,PREV C-SEC"]
["6009","REFUND (ACCOUNT)"]
["60605","PR EXCISE CAROTID BODY+CAROTID ARTERY"]
["6140019","HC MRI EXT LOW JNT W CON"]
["61540","PR CRANIOT W BONE FLAP OTHER LOBE W/O ECOG"]
["61850","PR IMP ELECTRDS,CORT,DRILL,BURR"]
["6210012","HC LOCKING NEPHROSTOMY SET"]
["6210128","HC VASCULAR SHEATH 22 FR"]
["6210162","HC CYTOLOGY BRUSH"]
["6210207","HC DILATATION CATH,CURVED"]
["6210321","HC NEEDLE,BONE OSTEO-COAX CURVED"]
["62258","PR REMOVE & REPLACE CSF SHUNT"]
["63087","PR REMV VERT BODY,LO THOR/LUMB,ONE"]
["63276","PR BX/EXCIS SPINAL TUMOR,XDURAL,THOR"]
["63600022","HC DTAP-HIB-IPV INACTIVATED VACCINE IM"]
["63600140","HC RABIES VACCINE, IM,TRAVEL"]
["63600173","HC PNEUMOCOCCAL VACCINE,23-VALENT,ADULT,DPH"]
["64451","NJX AA&/STRD NRV NRVTG SI JT"]
["64510001","HC NJX ANES STELLATE GANGLION CRV SYMPATHETIC"]
["64597001","HC INS/RPLCM PRQ ELTRD RA PN EA"]
["64820","PR SYMPATHECTOMY,DIGITAL ARTERIES, EA"]
["64898","PR NERV GRFT,ARM/LEG,MULT,>4 CM"]
["65760","PR KERATOMILEUSIS"]
["66020001","HC INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX"]
["67010001","HC RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT"]
["67208","PR DESTRUC RETINAL LESN,CRYOTHERAPY"]
["67400001","HC EXPLORE/BIOPSY EYE SOCKET"]
["67971","PR RECONSTRUC EYELID,<2/3,ONE STAGE"]
["68440P","SNIP INCIS OF LACRIMAL PUNCTUM"]
["69540","PR REMV AURAL POLYP"]
["69717","PR REPLCE OSS IMP, SKULL,W/PERQ ATTACH TO EXT SP"]
["7000008","HC EXTREM CAST MAJOR LONG"]
["70490000","HC CT,NECK;W/O(DIAG)"]
["70553000","HC CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL"]
["72040000","HC CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS"]
["72130000","HC CT,T SPINE;W/WO"]
["72193000","HC CHG CT PELVIS W/CONTRAST MATERIAL"]
["73120000","HC CHG RADEX HAND 2 VIEWS"]
["73521000","HC CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS"]
["74020","CHG X-RAY ABDOMEN 2 VW"]
["74190","CHG X-RAY PERITONEUM"]
["74301","CHG X-RAY OPER CHOLANGIO ADDNL SET"]
["7500011","HC COLD BIOPSY"]
["7500056","HC SNARE"]
["75805","CHG LYMPHANGIO ABD/PELV UNILAT"]
["75887001","HC CHG PERCUT XHEPATIC PORTOGRAM"]
["75995","PR ATHERECTOMY TRANSLUMNL VISCERAL"]
["76100069","HC EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM"]
["76100103","HC SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC"]
["76100217","HC CHEMICAL PEEL NONFACIAL EPIDERMAL"]
["76100251","HC DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM"]
["76100365","HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>"]
["76100410","HC CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ"]
["76100444","HC CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ"]
["76100558","HC APPLICATION CAST SHOULDER HAND LONG ARM"]
["76100592","HC APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM"]
["76100706","HC DRG ABSC CST HMTMA VESTIBULE MOUTH COMP"]
["76100751","HC BIOPSY OROPHARYNX"]
["76100785","HC UPPER GI NDSC ULTRASOUND GUIDED BIOPSY"]
["76100899","HC ANOSCOPY W/BX SINGLE/MULTIPLE"]
["76100944","HC NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY"]
["76101046","HC CAUTERY CERVIX ELECTRO/THERMAL"]
["76101091","HC DELIVERY PLACENTA SEPARATE PROCEDURE"]
["76101125","HC MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES"]
["76101239","HC RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT"]
["76101284","HC RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING"]
["76101387","HC POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM"]
["76101433","HC BONE MARROW ASPIRATE &BIOPSY"]
["76101555","HC PROCTOSGMDSC RIGID ABLATION LESION"]
["76101617","HC ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC"]
["76299997","HC OBSERVATION HOURLY- OPTIME"]
["76805PN","US PG UTER F&MAT AFTER 1ST TRI 1/1ST GESTATION PN"]
["76830","CHG ECHOGRAPHY,TRANSVAGINAL"]
["76940","CHG US GUIDE, TISSUE ABLATION"]
["77055000","HC DIG DIAG MAMMOGRAPHY"]
["77084","CHG MRI, BONE MARROW"]
["77373001","HC SRS FRACTIONATED 1-5 BODY; 2-5 CRANIAL"]
["77469","PR INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT"]
["78140","CHG RED CELL SEQUESTRATION"]
["78227000","HC CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ"]
["78315000","HC CHG BONE &/JOINT IMAGING 3 PHASE STUDY"]
["78615","PR CEREBRAL BLOOD FLOW"]
["78761001","HC CHG TESTICULAR IMAGING & FLOW"]
["80150","CHG ASSAY OF AMIKACIN"]
["80171","PR DRUG SCREEN QUANTITATIVE GABAPENTIN"]
["80195001","HC DRUG SCREEN QUANTITATIVE SIROLIMUS"]
["80361000","HC CHG DRUG SCREENING OPIATES 1 OR MORE"]
["8042","DENIAL WO - MED NECESSITY"]
["81206001","HC P210 BCR-ABL1"]
["81229001","HC CYTOG ALYS CHRML ABNR SNPCGH LSS"]
["81256000","HC CHG HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS"]
["81331001","HC PRADER-WILLI/ANGELMAN"]
["81353001","HC TP53 GENE KNOWN FAMIL VRNT"]
["81470","CHG X-LINKED INTELLECTUAL DBLT GENOMIC SEQ ANALYS"]
["81552001","HC ONC UVEAL MLNMA MRNA 15 GENE"]
["82273","CHG BLOOD,OCCULT,BY PEROX,OTHER SOURCES"]
["82387","CHG ASSAY OF CATHEPSIN-D"]
["82523000","HC CHG COLLAGEN CROSS LINKS ANY METHOD"]
["82784001","HC CHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LSS"]
["82963","CHG ASSAY OF GLUCOSIDASE"]
["83605","CHG ASSAY OF LACTIC ACID"]
["83805","CHG ASSAY OF MEPROBAMATE"]
["83897","CHG MOLECULAR DIAG NUCLEIC TRANSFER"]
["84181001","HC PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID"]
["84375","CHG CHROMATOGRAM ASSAY, SUGARS, TLC OR PAPER"]
["85004000","HC AUTO DIFF"]
["85230","CHG BLOOD CLOT FACTOR VII TEST"]
["85345","CHG COAGULATION TIME, LEE-WHITE"]
["86038000","HC CHG ANTINUCLEAR ANTIBODIES ANA"]
["86185","CHG COUNTERIMMUNOELECTROPHORESIS"]
["86381","MITOCHONDRIAL ANTIBODY EA SENDOUT"]
["86611000","HC CHG ANTIBODY BARTONELLA"]
["86664","CHG EPSTEIN-BARR ANTIBODY,NUCLEAR"]
["86769000","HC ANTIBODY; SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2"]
["86813000","HC CHG HLA TYPING A/B/C MULTIPLE ANTIGENS"]
["87110","CHG CULTURE, CHLAMYDIA"]
["87185","CHG ANTIBIOTIC SENS,ENZYME DETECTION,EACH"]
["87272000","HC CHG IAADI CRYPTOSPORIDIUM"]
["87490000","HC CHG IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ"]
["87523","HEPATITIS D QUANTIFICATION"]
["87810","CHG CHYLMD TRACH ASSAY W/OPTIC"]
["88020","CHG AUTOPSY COMPL,W/O CNS"]
["88273","CHG CYTOGENETICS, 10-30"]
["88307000","HC CHG LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM"]
["88350A","PR IMMUNOFLUORESCENCE PER SPEC ADD SINGL ATB STAIN"]
["89398","CHG UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE"]
["9005","ROI CREDIT ADJUSTMENT/WRITE-OFF"]
["90651","PR 9VHPV VACC 2/3 DOSE SCHED IM USE"]
["90672.1","CR BUILD ONLY - INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL,DPH,FLUMIST"]
["90686.3","CR BUILD ONLY - FLU VAC NO PRSV 4 VAL 3 YRS+,TRAVEL,FLUZONE"]
["90749002","HC RESEARCH SHINGRIX VACCINE"]
["90801","PR PSYCHIATRIC DIAGNOSTIC INTERVIEW"]
["90964","PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, 2-11 YR OLD"]
["91113001","HC GI TRC IMG INTRAL COLON I&R"]
["91309001","HC SARSCOV2 VAC 50 MCG/0.5 ML IM MODERNA"]
["92012001","HC OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT"]
["9210002","HC DUPLEX ABD/PEL VASC STUDY,COMP"]
["92273001","HC FULL FIELD ERG W/I&R"]
["92325","PR MODIFICATION OF CONTACT LENS"]
["92550","PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS"]
["92582001","HC CONDITIONING PLAY AUDIOMETRY"]
["92610001","HC EVAL ORAL&PHARYNGEAL SWLNG FUNCJ"]
["92995","PR CORONARY ATHERECTOMY PERCUT,SINGLE"]
["93235","PR ECG MONITOR/24 HRS, COMPUTERIZED MONITOR, COMPLETE"]
["93321001","HC DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD"]
["93505","PR ENDOMYOCARDIAL BIOPSY"]
["93572","PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL"]
["93724","PR ANALYZE PACER SYS"]
["93886001","HC TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL"]
["94060001","HC BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN"]
["94617","PR EXERCISE TEST FOR BRONCHOSPASM"]
["94729","PR DIFFUSING CAPACITY"]
["95199","PR ALLERGY IMMUNOLOGY SERV,UNLISTED"]
["95783","PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM"]
["95930001","HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R"]
["95970001","HC ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM"]
["96102","PR PSYCHOLOGIC TESTING BY TECHNICIAN"]
["96374","PR INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG"]
["96450","PR CHEMOTHER,CNS,W/LUMBAR PUNCTURE"]
["97163001","HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS"]
["97551001","HC CAREGIVER TRAINING EA ADDL 15"]
["97814001","HC ACUPUNCT W/ ELEC STIMUL ADDL 15M"]
["99173001","HC SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT"]
["99204001","HC OFFICE OUTPATIENT NEW 45 MINS MET OR EXCEEDED"]
["99291","PR CRITICAL CARE, E/M 30-74 MINUTES"]
["99328","PR DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES"]
["99433","F/U NEWBORN CARE,HOSP,PER DAY"]
["99473001","HC SELF-MEAS BP PT EDUCAJ/TRAIN"]
["99499A","NON PHYSICIAN PRACTITIONER"]
["99999992","HC OBS NO CHARGE"]
["A0190T","INTRAOCULAR RADIATION SRC APPLICATOR PLACEMENT"]
["A0395T","PR HDR ELECTRONIC BRACHYTHERAPY NTRSTL/INTRCAV"]
["A0437T","IMPLANTATION OF NON-BIOLOGIC OR SYNTHETIC IMPLANT (EG, POLYPROPYLENE) FOR FASCIAL REINFORC"]
["A0492T","PR ABLATIVE LASER TREATMENT, NON-CONTACT, FULL FIELD AND FRACTIONAL ABLATION, OPEN WOUND"]
["A0767T","PR TC MAG STIMJ FCSD LW FRQ EMGNT PLS PN 1STTX EA"]
["A10010","PR FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL"]
["A11730","PR ANESTH REMOVAL OF NAIL PLATE"]
["A12031","PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM"]
["A15732","PR MUSCLE-SKIN FLAP,HEAD/NECK"]
["A15837","PR EXCISE EXCESS SKIN TISSUE,FOREARM"]
["A17003","PR DESTRUC BENIGN/PREMAL,2-14 LESIONS"]
["A20005","PR I&D SOFT TISSUE ABSCESS SUBFASCIAL"]
["A20661","PR APPLY/REMOVE HALO CRANIAL"]
["A20972","PR BONE-SKIN GRAFT, MICROVASC METATARS"]
["A21249","PR RECONSTR JAW,FULL,ENDO IMPLNT"]
["A21407","PR OPEN RX FX ORBIT W IMPLANT"]
["A22327","PR OPEN POST RX THOR VERT FX,1 LVL"]
["A22819","PR KYPHECTOMY, 3 & MORE SEGMENT"]
["A23031","PR DRAIN INFECT SHOULDER BURSA"]
["A23929","PR SHOULDER SURG PROC UNLISTED"]
["A24330","PR FLEXORPLASTY,ELBOW"]
["A25125","PR EXCIS BENIGN LESN RAD/ULNA,AUTOGRFT"]
["A25391","PR OSTEOPLASTY,RADIUS OR ULNA,LENTH W/GRAFT"]
["A26180","PR EXCIS FINGER TENDON FLEXOR"]
["A26433","PR REPAIR EXTEN TENDON,DISTAL INSERT,OPEN"]
["A26548","PR FIX FINGER,VOLAR PLATE,I-P JT"]
["A27100","PR XFER ABD MUSC TO GR TROCHANTER"]
["A27202","PR OPEN REPAIR COCCYGEAL FRACTURE"]
["A27445","PR PLASTY KNEE,CONSTRAINED PROSTHESIS"]
["A27511","PR OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O EXTENSION"]
["A27618","PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM"]
["A28008","PR INCISION OF FOOT/TOE FASCIA"]
["A28111","PR FULL EXCIS 1ST METATARSAL HEAD"]
["A28615","PR OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION"]
["A29130","PR APPLY FINGER SPLINT,STATIC"]
["A29720","PR REPAIR SPICA/BODY/JACKET CAST"]
["A30545","PR REPAIR CHOANAL ATRESIA,TRANSPALATIN"]
["A31201","PR REMOV ETHMOID SINUS,INTRANASAL,TOTL"]
["A31629","PR BRONCHOSCOPY,TRANSBRON ASPIR BX"]
["A31899","PR AIRWAYS SURGICAL PROCEDURE UNLISTED"]
["A32900","PR REMOVAL OF RIB(S)"]
["A33226","PR REPOSIT PREV IMPLANTED CARDIAC ELECTRODE"]
["A33271","PR INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE"]
["A33611","PR REDOUB VENT W IV TUNNEL"]
["A33771","PR REXPOSTN GRT VES W ENLARGMT VSD"]
["A33982","PR REPLACE VENT ASST DEV, IMPLANT INTRACORP, SINGLE VENT, W/O BYPASS"]
["A34714","PR OPEN FEMORAL ARTERY EXPOSURE WITH CREATION OF CONDUIT FOR DELIVERY OF ENDOVASCULAR PR"]
["A35112","PR REART RUPTURE,SPLENIC"]
["A35616","PR BYPASS GRAFT OTHR,SUBCL-AXILL"]
["A35875","PR THROMBECTOMY A-V GRAFT, EXC HEMODIALYSIS"]
["A36575","PR REPAIR CV CATH W/O SUBQ PORT OR PUMP"]
["A36901","INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPH"]
["A37220","PR REVASCULARIZE ILIAC ARTERY,ANGIOPLASTY, INITIAL VESSEL"]
["A38555","PR REMOVAL CYST HYGROMA NEUROVASC DISS"]
["A40527","PR FULL THICK EXCIS LIP,FIX W XFLAP"]
["A42210","PR RECONST CLEFT PALATE,BONE GRFT"]
["A42410","PR EXC PAROTD LESN,LATER LOBE"]
["A42720","PR INC/DRAIN RETROPHARYNG ABSCESS,ORAL"]
["A43226","PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION"]
["A43269","PR ERCP,RMV F.B./CHANGE STENT"]
["A43645","PR LAP GASTR BYPASS INCL SMLL INT RECON"]
["A4378","PR DRAINABLE RUBBER PCH W/O FP"]
["A4399","PR OSTOMY IRRIG CONE/CATH W BRS"]
["A44361","PR SMALL BOWEL ENDOSCOPY,BIOPSY"]
["A44603","PR SUTURE SM INTEST,MULTPL PERF"]
["A45378","PR ANESTH COLONOSCOPY,DIAGNOSTIC"]
["A4556","PR ELECTRODES, PAIR"]
["A46615","PR ANOSCOPY,ABLATE LESION"]
["A47000","PR NEEDLE BIOPSY LIVER"]
["A4728","PR DIALYSATE SOLUTION, NON-DEX"]
["A48540","PR ANAST PANC CYST-BOWEL,ROUX-EN-Y"]
["A49185","PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID"]
["A50010","PR EXPLORATION OF KIDNEY"]
["A50390","PR PERCUT DRAIN/INJECT RENAL CYST"]
["A50548","PR NEPHRECTOMY, W/PART. URETECTOMY"]
["A51535","PR CYSTOTOMY,REPAIR URETEROCELE"]
["A51798","PR MEAS,POST-VOID RES,US,NON-IMAGING"]
["A53446","PR REMOVAL,INFLATABLE SPHINCTER"]
["A54120","PR REMOVAL PENIS,PARTIAL"]
["A5514","PR MULT DEN INSERT DIR CARV/CAM"]
["A55880","ABLATION OF MALIGNANT PROSTATE TISSUE, TRANSRECTAL, WITH HIGH INTENSITY-FOCUSED ULTRASOUND (HIFU), INCLUDING ULTRASOUND GUIDANCE"]
["A57120","PR CLOSURE OF VAGINA"]
["A58340","PR CATH/INJECT HYSTEROSALPINGOGRAM"]
["A58671","PR LAP,TUBAL BLOCK BY DEVICE"]
["A60100","PR BIOPSY OF THYROID,PERCUT"]
["A61120","PR BURR HOLE VENTRICULAR PUNCTURE"]
["A61521","PR EXCIS INFRATENT MIDLINE TUMOR"]
["A61791","PR STEREO TREAT TRIGEMINAL TRACT"]
["A62120","PR REPAIR ENCEPHALOCELE,VAULT"]
["A62268","PR PERCUT DRAIN SPINAL CORD CYST"]
["A63056","PR DECOMPRESS SPINAL CORD,1 SEG"]
["A63275","PR BX/EXCIS SPINAL TUMOR,XDURAL,CERV"]
["A6450","PR LT COMPRES BAND >=5/YD"]
["A64616","PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA"]
["A6503","PR COMPRES BURNGARMENT FACEHOOD"]
["A65272","PR REPAIR CONJUNC LAC,REARRANG,NO HOSP"]
["A65737","HSPC SLP VISIT"]
["A67031","PR LASER SURGERY,SEVER VITREOUS STRANDS"]
["A67399","PR EYE MUSCLE SURG PROC UNLISTED"]
["A69005","PR DRAIN EXT EAR ABSC/BLOOD,COMPLIC"]
["A69511","PR MASTOIDECTOMY,RADICAL"]
["A69720","PR RELEASE FACIAL NERVE,LAT TO GANGLION"]
["A70544","CHG MR ANGIO, HEAD"]
["A71260","CHG CAT SCAN OF CHEST CONTRAST"]
["A74000","RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW"]
["A74280","RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON"]
["A76102","RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI"]
["A77761","INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE"]
["A78299","UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE"]
["A9280","PR ALERT DEVICE, NOC"]
["A93314","ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY"]
["A9523","DELETED 2084"]
["A9568","PR TECHNETIUM TC99M ARCITUMOMAB"]
["A95990","REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN"]
["ADT65","VISITOR RESTRICTION"]
["ANE116","HC ANES ADMIN REG PAIN CONTROL"]
["AUD48","SPONTANEOUS NYSTAGMUS TEST POSITIONAL"]
["B4152","PR EF CALORIE DENSE>/=1.5KCAL"]
["B6666","HAIR REMOVAL UNDERARMS"]
["C000340","HAIR RMV LSR PRE-SURGICAL SCROTUM"]
["C001002","GLYCOLIC PEEL W/ NURSE/AESTH"]
["C041000","PR EXTENDED PHYSICIAN CONSLT. LEVEL 4"]
["C1754","PR CATHETER, INTRADISCAL"]
["C1819","PR TISSUE LOCALIZATION-EXCISION"]
["C8900","PR MRA W/CONT, ABD"]
["C8932","PR MRA, W/O DYE, SPINAL CANAL"]
["C9351","PR ACELLULAR DERM TISSUE PERCM2"]
["C9474","PR INJ, IRINOTECAN LIPOSOME"]
["C9733","PR NON-OPHTHALMIC FVA"]
["CATH25","INTRACARDIAC ECHOCARDIOGRAM"]
["CCA19081","BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID (HISTORICAL)"]
["CCIMG70130","RADEX MASTOIDS COMPL MINIMUM 3 VIEWS SIDE (HISTORICAL)"]
["CCIMG73140","RADEX FINGR MINIMUM 2 VIEWS (HISTORICAL)"]
["CCIMG9083","REFERRAL FOR UPPER GI (HISTORICAL)"]
["CON29","IP CONSULT TO NEUROPSYCHOLOGY"]
["CON61","IP CONSULT TO IMMUNOLOGY"]
["CON95","IP CONSULT TO EDUC SERVICES"]
["COR130","NO VTE PROPHYLAXIS: NO INDICATION OR CONTRAINDICATION"]
["D0171","PR RE-EVALUATION - POST-OPERATIVE OFFICE VISIT"]
["D0380","PR CONE BEAM CT IMAGE CAPTURE WITH LIMITED FIELD OF VIEW - LESS THAN ONE WHOLE JAW"]
["D0502","PR OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT"]
["D2930","PR PREFABRICATED STAINLESS STEEL CROWN - PRIMARY TOOTH"]
["D3222","PR PART PULP FOR APEXOGENESIS"]
["D5610","PR REPAIR RESIN DENTURE BASE"]
["D5916","PR OCULAR PROSTHESIS"]
["D5987","PR COMMISSURE SPLINT"]
["D6605","PR RETAINER INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES"]
["D6930","PR RE-CEMENT OR RE-BOND FIXED PARTIAL DENTURE"]
["D7910","PR SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM"]
["D8020","PR LIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION"]
["D9999","PR UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT"]
["DIET17","DIET, PEDIATRIC"]
["DNS519","PEDIATRIC TUBE FEEDING CYCLIC"]
["E0293","PR HOSP BED VAR HT W/O RAIL W/"]
["E0460","PR NEG PRESS VENT PORTABL/STATN"]
["E0757","DELETED 2284"]
["E0946","PR FRACTURE FRAME DUAL W CROSS"]
["E0999","PR WHEELCHR PNEUMATIC TIRE W/WH"]
["E1353","PR OXYGEN SUPPLIES REGULATOR"]
["E1805","PR ADJUST WRIST EXT/FLEX DEVICE"]
["E2385","PR TUBE, PNEUMATIC CASTER TIRE"]
["E2622","PR ADJ SKIN PRO W/C CUS WD<22IN"]
["ECH14","ECHOCARDIOGRAM TRANSTHORACIC"]
["ENT529","EXCISION OR DESTRUCTION, INTRANASAL LESION; INTERNAL APPROACH"]
["ENT574","NASAL / SINUS ENDOSCOPY BIOPSY; NASEOPHARYNX, VISIBLE LESION SIMPLE"]
["EQ117","COMPRESSION STOCKINGS"]
["EQ30","CANE"]
["EQ78","LEG EXTENDER SETUP"]
["EXT18","EXT LIPID PANEL"]
["EXT43","EXT ACETAMINOPHEN LEVEL"]
["EXT5596","EXT QUANTIFERON(R)-TB GOLD (CLIENT INCUBATED)"]
["EXT5696","EXT HCV RNA QUANTITATIVE BY REAL TIME PCR."]
["EXT5958","EXT PROTEIN ELECTROPHORESIS - URINE"]
["EXT903","IMG 7 FIELD PHOTOS WITH INTERP/REVIEW"]
["F6666","FATGRAFT"]
["G0082","PR CARE MAN H V EXT PT 30 M"]
["G0137","INTEN OUTPT SVS,MIN 9 PR 7 D"]
["G0215","DELETED 2376"]
["G0382","LEV 3 HOSP TYPE B ED VISIT"]
["G0422","PR INTENS CARDIAC REHAB W/EXERC"]
["G170039","PR IDE VASQ DEVICE"]
["G2071","MED TX REMOVE IMPLANT"]
["G4001","PR DIAGNOSTIC RAD SS"]
["G6008","PR RADIATION TREATMENT DELIVERY"]
["G6055","PR ASSAY OF NICOTINE"]
["G8221","PR PT INELIG FOR DVT PROPH"]
["G8308","PR POAG W/ IOP NOT DOC PLAN"]
["G8475","PR ACE/ARB THXPY NOT RXÆD"]
["G8536","PR NO DOC ELDER MAL SCRN"]
["G8572","PR NO STER WD IFX"]
["G8686","PR TOBA SMKR CURR OR 2 HAND EXP"]
["G8765","PR CATARACT MG QUAL ACT PERFORM"]
["G8946","PR MIBM BUT NO DX OF BREAST CA"]
["G8991","PR OTHER PT/OT GOAL STATUS"]
["G9125","PR ONC DX CML BLAST PHASE"]
["G9176","PR SPEECH LANG D/C STATUS"]
["G9268","PR DOC COMP OR MORT W IN 90D"]
["G9410","PR ADMIT W/IN 180D REQ REMOV"]
["G9476","PR VOLUN SERVICE AT HOSPICE"]
["G9526","PR NO REASON, NO REFER HOSPICE"]
["G9650","PR DOC PT NO THER CHG OR CONTRA"]
["G9695","PR LONG ACT INHAL BRONCHDIL PRE"]
["G9798","PR D/C AMI BTW 7/1-6/30 MST PER"]
["G9843","PR KRAS OR NRAS GENE MUTATION"]
["G9896","PR DOC PT RSN NO ADR DEP THRPY"]
["GI15","ENDOSCOPY, SMALL BOWEL"]
["GI55","ESOPHAGEAL BRAVO PH CAPSULE RESULTS / INTERPRETATION"]
["H0003","PR ALCOHOL AND/OR DRUG SCREENIN"]
["H0019009","HC BEHAVIORAL HEALTH; LONG TERM RESIDENTIAL -  YOUTH RESIDENTIAL SUBSTANCE USE DISORDER TREATMENT"]
["H2020001","HC THERAPEUTIC BEHAVIORAL SERVICES, PER DIEM"]
["H2037001","HC DEVELOPMENTAL DELAY PREVENTION ACTIVITIES, DEPENDENT"]
["HS000032","HC BINDER;ABDOMINAL"]
["HS000147","HC SHEATH KIT;BIV ACCESS SJM"]
["HS000181","HC CATH,THROMB/EMB,LVL C"]
["HS000295","HC APLIGRAFT 44CM2"]
["HS000329","HC STRATTICE 10X25 CM"]
["HS000374","HC PORTACATH ANY"]
["HS000488","HC PENUMBRA REPERFUSION 026"]
["HS000522","HC MARKSMAN CATHETER 160CM"]
["HS000636","HC PLUG BONE 1"]
["HS000670","HC PRESSARY, NON RUBBER,ANY TYPE"]
["HS000784","HC PACK EP CUSTOM STERILE"]
["HS000829","HC JUVEDERM"]
["HS000863","HC UPP EXT FX ORTHOSIS HUMERAL"]
["IMG1081","US ABDOMINAL AORTA LIMITED"]
["IMG1114CHG2","IR PORTAL VEIN CATHETERIZATION"]
["IMG1206","US LOWER EXTREMITY ARTERIES COMPLETE"]
["IMG1249","CT MANDIBLE W WO CONTRAST"]
["IMG1280","XR LUMBAR SPINE OBLIQUES ONLY"]
["IMG1383","CT TIBIA FIBULA RIGHT W CONTRAST"]
["IMG1424","CT ABDOMEN PELVIS ONLY W RECTAL AIR"]
["IMG1538","XR FOOT BILATERAL AP LATERAL AND OBLIQUE"]
["IMG1590","CT SKULL W CONTRAST"]
["IMG1631","CT TIBIA FIBULA LEFT W CONTRAST"]
["IMG1727","CT RADIUS ULNA LEFT WO CONTRAST"]
["IMG1768","MRI HIP RIGHT ARTHROGRAM WO CONTRAST"]
["IMG1861","CT PET NASAL CAVITY EAR SINUSES DIAGNOSIS"]
["IMG1901","XR HIP LEFT STRESS W CONTRALATERAL JOINT"]
["IMG1972A","BI MAMMO NEEDLE LOCALIZATION LEFT"]
["IMG2051","XR LEFT FOOT SESAMOID AND AP"]
["IMG2092","XR PEDI (INFANT) BILATERAL LOWER EXTREMITIES - LESS THAN A YEAR"]
["IMG2185","NM SPECT DCT (ABD/ PLVS WITH)"]
["IMG2224","CT DRAINAGE-RENAL PERIRENAL INCLUD MODERATE SEDATION"]
["IMG2265","CT LIMITED FU AND SPECT PET EXAM"]
["IMG2355","RESEARCH CT OF THE PELVIS WITH CONTRAST"]
["IMG2387","MRI UPPER EXTREMITY OTHER THAN JOINT LEFT WITH AND WITHOUT CONTRAST"]
["IMG2480","NM RENAL SCAN, PERF AND FUNCTION"]
["IMG251","BIDMC RESEARCH MRI BRAIN WITHOUT CONTRAST"]
["IMG2549","US FIRST TRIMESTER DATING"]
["IMG2626","IR BRONCHOSCOPY WITH BIOPSY 1ST LOBE"]
["IMG2658","IR FISTULAGRAM DIALYSIS LEFT"]
["IMG2722","NM BRAIN- PERFUSION BRAIN DEATH"]
["IMG2753","NM MYOCARDIAL PERFUSION SPECT SCAN - EXERCISE STRESS"]
["IMG2844","SP ARTHERECTOMY, EA ADD PERIPH"]
["IMG2882","SP INTRAVASCUALR ULTRASOUND ADDITIONAL VESSEL"]
["IMG2907CHG1","IR ANGIO VERTEBRAL BILATERAL CHARGE"]
["IMG3008","NM LUNG VENT PERF SCAN, QUANT"]
["IMG3039","PET IMAGING RESTAGING, COLORECTAL CANCER"]
["IMG3142","DOB,LUMBOSACRAL SPINE, COMPLETE W/OBLIQUES"]
["IMG3183","SOUTHBOSTON,ACJOINTS"]
["IMG3214","LEFT STERNOCLAVICULAR JOINTS"]
["IMG330","RESEARCH DFCI 19-403 STUDY H-41709 CT THORAX W/O CONTRAST"]
["IMG3328","DORCHESTER, RIGHT KNEE WITH PATELLA AND TUNNEL"]
["IMG3430","PET OUTSIDE IMAGING CONSULT WITH DICTATION"]
["IMG3469","SOUTH BOSTON, LEFT CLAVICLE"]
["IMG3559","RESEARCH CT CHEST W/O CONTRAST ADULTS WITH HS"]
["IMG3773","CODMAN SQUARE, RIGHT SHOULDER 1 VIEW"]
["IMG3880","DORCHESTER, RIGHT SHOULDER 1 VIEW"]
["IMG4023","IR BIOPSY LYMPH NODE"]
["IMG4056","MRA UPPER EXTREMITY LEFT WITH AND WITHOUT CONTRAST"]
["IMG4101CHG6","IR BIOPSY SOFT TISSUE THIGH OR KNEE SUPERFICIAL CT GUIDED CHARGE"]
["IMG4118CHG1","IR DRAINAGE LIVER CT GUIDED CHARGE"]
["IMG4137","IR FINE NEEDLE ASPIRATION"]
["IMG419","NM MYOCARDIAL INFARCTION AVID"]
["IMG4205","IR REQ BIOPSY/ASPIRATION/FIDUCIAL PLACEMENT"]
["IMG467","RESEARCH H-42145 STUDY MRV BRAIN WITHOUT CONTRAST"]
["IMG5004","SOUTH BOSTON, ULTRASOUND ABDOMINAL LIMITED"]
["IMG5041","RESEARCH CT KYOWA CT RIGHT UPPER EXTREMITY WITHOUT CONTRAST"]
["IMG536","US OB LIMITED 1 OR MORE FETUSES"]
["IMG576","MRI BRAIN WITH AND WITHOUT CONTRAST AND MRA HEAD (VESSEL WALL PROTOCOL)"]
["IMG6077","US PEDI PELVIC NON-OB W/DOPPLER"]
["IMG6103","VL VENOUS DUPLEX SCAN BILATERAL"]
["IMG627CHG1","IR INFERIOR VENACAVAGRAM FL GUIDED CHARGE"]
["IMG685","IR VENOGRAM ADRENAL BILATERAL SELECTIVE"]
["IMG7020","NM PET/CT (F18 FDG) WITH DIAGNOSTIC CT NECK W/O CONTRAST"]
["IMG7121","PET CT BRAIN WITH CONTRAST"]
["IMG7153","RESEARCH CARDEAS CHEST 2, VIEWS"]
["IMG7192","MRI BRAIN DBS PROTOCOL WITH AND WITHOUT CONTRAST"]
["IMG755","FL HYPOTONIC DUODENOGRAM"]
["IMG7804","RESEARCH H-42963 STUDY MRI ABDOMEN WITH CONTRAST"]
["IMG9157","BI MAMMO DIGITAL TOMOSYNTHESIS DIAGNOSTIC RIGHT (BIRAD 0)"]
["IMG9255","MRCP W SECRETIN WITH AND WITHOUT CONTRAST"]
["IMM208","COVID-19 VACCINE, MRNA, LNP-S, INTRAMUSCULAR PF INJECTION (0.3 ML DOSE)"]
["IMM39","HIB PRP-T CONJUGATE VACCINE 4 DOSE IM"]
["IMM73","HEPATITIS B IMMUNE GLOBULIN"]
["IR661","IR ANGIOGRAM PELVIS SELECTIVE OR SUPRASELECTIVE"]
["IR695","IR TRANSCATHETER THERAPY EMBOLIZATION"]
["J0287","PR AMPHOTERICIN B LIPID COMPLEX"]
["J0574","PR BUPRENORPH/NALOX 6.1 TO 10MG"]
["J0641","PR LEVOLEUCOVORIN INJECTION"]
["J1306","PR INJECTION, INCLISIRAN, 1 MG"]
["J1530","PR GAMMA GLOBULIN 8 CC INJ"]
["J2010","PR LINCOMYCIN INJECTION"]
["J2360","PR ORPHENADRINE INJECTION"]
["J2590","PR OXYTOCIN INJECTION"]
["J3371","PR INJ, VANCOMYCIN HCL (MYLAN)"]
["J7040","PR NORMAL SALINE SOLUTION INFUS"]
["J7509","PR METHYLPREDNISOLONE ORAL"]
["J7639","PR DORNASE ALPHA INHAL SOL U D"]
["J9092","PR CYCLOPHOSPHAMIDE 2.0 GRM INJ"]
["J9098","PR CYTARABINE LIPOSOME"]
["J9302","PR OFATUMUMAB INJECTION"]
["K0072","PR FRNT CSTR CMPL SEM-PNEUM TIR"]
["K0618","DELETED 2612"]
["K0838","PR PWC GP 2 HD SING POW OPT CAP"]
["L0491","PR TLSO 2 PIECE RIGID SHELL"]
["L0820","PR HALO CERVICAL INTO BODY JACK"]
["L1910","PR AFO SING BAR CLASP ATTACH SH"]
["L2188","PR QUADRILATERAL BRIM"]
["L2550","PR THIGH/WGHT BEAR HIGH ROLL CU"]
["L3460","PR SHOE HEEL NEW RUBBER STANDAR"]
["L3764","PR EWHO W/JOINT(S) CF"]
["L4350","PR ANKLE CONTROL ORTHOSI PREFAB"]
["L5331","PR HIP DISART CANADIAN SACH FT"]
["L5810","PR ENDOSKEL KNEE-SHIN MNL LOCK"]
["L5969","PR AK/FT POWER ASST INCL MOTORS"]
["L6382","PR POSTOP DSG CAST CHG ELB DIS/"]
["L6870","PR HAND CHILD MITT"]
["L7025","PR ELECTRON HAND MYOELECTRONIC"]
["L8600","PR IMPLANT BREAST SILICONE/EQ"]
["L8680","IMPLT NEUROSTIM ELCTR EACH"]
["LAB1016","H. PYLORI (C-13), BLOOD"]
["LAB1115","HIGH MOLECULAR WEIGHT KININOGEN"]
["LAB1146","ALLERGEN, FOOD, EGG YOLK IGG"]
["LAB1246","INFLUENZA B ANTIBODY, IGM"]
["LAB1286","BLOOD TYPING, PATERNITY TEST"]
["LAB1372","VARICELLA ZOSTER DNA, QUANTITATIVE"]
["LAB141","URIC ACID"]
["LAB1438","ALLERGEN BAYLEAF (LAUREL) IGE"]
["LAB1540","ALLERGEN SILK IGE"]
["LAB1582","ALLERGEN GRAIN MILL DUST IGE"]
["LAB1675","ALLERGEN COCKROACH, AMERICAN IGE"]
["LAB1715","ALLERGEN HICKORY, WHITE IGE"]
["LAB1750D","PATHOLOGY, INTRAOPERATIVE CONSULT"]
["LAB1839","DONOR, HIV/HCV/HBV NAT PROCLEIX® WITH REFLEXES"]
["LAB1880","BUSULFAN LEVEL"]
["LAB2001","ANTI-SMITH ANTIBODY"]
["LAB2044","MYELIN-ASSOCIATED GLYCOPROTEIN (MAG) AB (IGM), EIA, CSF"]
["LAB2086","CFVANTAGE (R) CYSTIC FIBROSIS EXPANDED SCREEN"]
["LAB286","SPECIMEN HOLD"]
["LAB316","LOW MOLECULAR WGT HEPARIN"]
["LAB3505","PSCL PHERESIS"]
["LAB3546","SCREEN FOR C. DIPHTHERIAE"]
["LAB3587","MRSA PCR SCREEN URGENT (NASAL ONLY)"]
["LAB368","BENZODIAZEPINE, URINE, QUANTITATIVE"]
["LAB3725","CD26 (ABSOLUTE)"]
["LAB3828","TROPHERYMA WHIPPLEI DNA QUAL, REAL-TIME PCR"]
["LAB3859","SEROTONIN RELEASE ASSAY"]
["LAB39","VANCOMYCIN, TROUGH"]
["LAB3992","CH50"]
["LAB4031","FLUCONAZOLE, HPLC"]
["LAB4153","PINE NUT ALLERGEN"]
["LAB4184","STRIATED MUSCLE ANTIBODY WITH REFLEX TO TITER"]
["LAB4288","BG & COOX"]
["LAB4320","CANAVAN DISEASE MUTATION ANALYSIS"]
["LAB4361","CHOLESTEROL+TRYGLYCERIDE, PLEU"]
["LAB4464","FISH, AML/MDS, CEP8, TRISOMY 8"]
["LAB4495","FISH, PRENATAL SCREEN"]
["LAB45A","ALBUMIN"]
["LAB4639","IS HIV CONSENT COMPLIANT"]
["LAB467","CYTOMEGALOVIRUS ANTIBODY, IGG"]
["LAB4773","TRICYCLICS (SERUM)"]
["LAB4804","VENOUS BLOOD GAS, LYTES, WBCA,"]
["LAB5056","PROTEIN ELECTROPHORESIS, URINE"]
["LAB5128","G6PD,QUAL."]
["LAB5158","CD5"]
["LAB5253","ADENOSINE DEAMINASE, BLOOD"]
["LAB5289","CONNEXIN 26 DNA SEQUENCING TEST"]
["LAB5371","SCA17 DNA"]
["LAB5411","WALNUT BLACK FOOD (J.NIGRA) IGE*"]
["LAB5506","FISH, MULTIPLE MYELOMA,5,9,15"]
["LAB5546","JAK2 MUT (V617F) ANALYSIS,QNT,PL-BASED,LEUMETA(R)"]
["LAB5583","PHENOSENSE GT(R)"]
["LAB5678","BONE MARROW ASPIRATE"]
["LAB5714","ENTEROVIRUS BY PCR (CSF)"]
["LAB5804","MERRF, DNA ANALYSIS"]
["LAB5846","ANA NON-STANDARD 1:40 DILUTION"]
["LAB5887","UPHAMS HEALTH CARE MRN"]
["LAB5979","CYCLIC AMP - URINE"]
["LAB6014","BUN/CREATININE RATIO"]
["LAB6055","ALKALINE PHOSPHATASE, BODY FLUID"]
["LAB623","ALLERGEN ORCHARD GRASS"]
["LAB6270","PROTHROMBIN GENE MUTATION 20210G-A"]
["LAB6363","DENGUE PCR"]
["LAB639801","THYROGOBULIN (EXTERNAL LAB)"]
["LAB655","HSV NON-SPECIFIC ANTIBODY, IGM"]
["LAB678","DRUG SCREEN PANEL 1, SERUM"]
["LAB721","TISSUE TRANSGLUTAMINASE, IGG"]
["LAB783","HYPERSENSITIVITY PNEUMONITIS SEROLOGY"]
["LAB8020","FLT3 MUTATION ANALYSIS"]
["LAB8C","CYTOLOGY,GYN SPECIMEN"]
["LAB919","HIV-1 RNA, QUANTITATIVE, PCR"]
["LAB959","CALCIUM INFUSION TEST"]
["M1002","PR PLN TO ADRS PAIN NOT DOC"]
["M1036","PR ADT NO 180 DYS PHARMTHRY OUD"]
["M1160","PR PT ANPHX DUE TO MENGB BEF 13"]
["M1194","PR MED RSN NO IMP/CON MMR/MSI"]
["M1308","FLU IMMUNIZE NO ADMIN"]
["M1353","PTS NO CMPLT SUICD SAF PLN"]
["MHRBUT","MALE HAIR REMOVAL: BUTTOCKS"]
["NIRCHG36246","36246 - SPINAL CATHETER PLACEMENT, INITIAL SECOND ORDER ABDOMINAL, PELVIC, OR LE (BELOW DIAPHRAGM)"]
["NIRCHG75710","NIR ANGIOGRAM EXTREMITY UNILATERAL"]
["NUR1328","SPENCO BOOTS"]
["NUR1369","HEART RATE"]
["NUR1399","PROCEDURE"]
["NUR1504","DISCONTINUE FOLEY"]
["NUR15386","UVC/CVC LINE CARE"]
["NUR166C","NOTIFY RESEARCH TEAM OF PENDING DISCHARGE"]
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["NUR591","SUCTION DEEP LARYNGEAL"]
["NUR623","TRANSFUSE WHOLE BLOOD"]
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["OCN80069","RENAL FUNCTION PANEL (HISTORICAL)"]
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["OCN86301","IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 (HISTORICAL)"]
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["OCNLP2421","CHLAMYDIA/GC PROBE, URINE"]
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["OCNLS432","GLUTAMIC ACID DECARBOXYLASE ANTIBODY, SERUM (HISTORICAL)"]
["OCNLS779","ORGANISM IDENTIFICATION, YEAST"]
["OCNLT571","RFLX - PLATELET ESTIMATION"]
["OCNLV1167","ALLERGEN FOOD COCONUT IGE"]
["OCNLV1704","COCAINE METABOLITES GC/MS, URINE"]
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["OCNLV4445","SUSCEPTIBILITY PANEL, ANAEROBIC BACTERIA, MIC (GRADIENT)"]
["OCNLV6274","SSA AB"]
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["Q0247","SOTROVIMAB"]
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["CORRECTIONS","CORRECTIONS NORFOLK"]
["CORRECTIONS","CORRECTIONS NORFOLK CTY CORR"]
["CORRECTIONS","CORRECTIONS PLYMOUTH"]
["CORRECTIONS","CORRECTIONS PLYMOUTH CORR"]
["CORRECTIONS","CORRECTIONS SUFFOLK COUNTY"]
["CORRECTIONS","ZZZCORRECTIONS BAY STATE"]
["CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL"]
["CORRECTIONS","ZZZCORRECTIONS BRADSTON"]
["CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST"]
["CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED"]
["CORRECTIONS","ZZZCORRECTIONS CEDAR"]
["CORRECTIONS","ZZZCORRECTIONS CONCORD"]
["CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON"]
["CORRECTIONS","ZZZCORRECTIONS GARDNER"]
["CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK"]
["CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL"]
["CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB"]
["CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR"]
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["CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR"]
["CORRECTIONS","ZZZCORRECTIONS OLD COLONY"]
["CORRECTIONS","ZZZCORRECTIONS PLYMOUTH"]
["CORRECTIONS","ZZZCORRECTIONS PONDVILLE"]
["CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR"]
["CORRECTIONS","ZZZCORRECTIONS SHIRLEY"]
["CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI"]
["CORRECTIONS","ZZZORRECTIONS FRAMINGHAM"]
["FALLON","FALLON COMMUNITY PLAN"]
["FALLON","FALLON HMO STANDARD"]
["FALLON","FALLON POS STANDARD"]
["FALLON","FALLON PPO STANDARD"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG POS"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG PPO"]
["FALLON MEDICARE MANAGED","FALLON MCR MNG HMO"]
["FALLON SCO","FALLON SCO HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC PPO"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO"]
["HEALTH PLANS INC","HEALTH PLANS INC STANDARD"]
["HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE"]
["HSN","HSN STANDARD"]
["HSN","HSN TEMPORARY"]
["HSN BAD DEBT","HSN BAD DEBT"]
["HSN CONFIDENTIAL","HSN CONFIDENTIAL"]
["HSN DENTAL","HSN DENTAL"]
["HSN PARTIAL","HSN PARTIAL STANDARD"]
["HSN PARTIAL","HSN PARTIAL TEMPORARY"]
["HUMANA MEDICARE","HUMANA MEDICARE STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO"]
["MEDICARE","MEDICARE A&B"]
["MEDICARE","MEDICARE PART A ONLY"]
["MEDICARE","MEDICARE PART B ONLY"]
["MEDICARE","RAILROAD MEDICARE  RAILROAD"]
["NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD"]
["OXFORD HEALTH","OXFORD HEALTH STANDARD"]
["OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD"]
["SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD"]
["TRICARE EAST","TRICARE EAST PRIME (HMO)"]
["TRICARE EAST","TRICARE EAST SELECT"]
["TRICARE FOR LIFE","TRICARE FOR LIFE"]
["TUFTS","TUFTS CARELINK"]
["TUFTS","TUFTS HMO"]
["TUFTS","TUFTS POS"]
["TUFTS","TUFTS PPO"]
["TUFTS","TUFTS SELECT"]
["TUFTS","TUFTS SPIRIT"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED"]
["TUFTS MEDICARE","TUFTS MEDICARE HMO"]
["TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS"]
["TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS"]
["UBH HPHC","UBH HPHC"]
["UNICARE","UNICARE STANDARD"]
["UNITED","UNITED DEFINITY HRA"]
["UNITED","UNITED HP SHIP"]
["UNITED","UNITED HP STUDENT HEALTH"]
["UNITED","UNITED NAVIGATE"]
["UNITED","UNITED PASSPORT CONNECT"]
["UNITED","UNITED STANDARD"]
["UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO"]
["UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD"]
["UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG HMO"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG PPO"]
["UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO"]
["UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO"]
["UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD"]
["WELLCARE","WELLCARE HMO"]
["WELLCARE","WELLCARE PPO"]
["WELLCARE","WELLCARE STANDARD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS"]
["WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP"]
["WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE"]
["WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT"]
["WORKERS COMP","WORKERS COMP CCMSI"]
["WORKERS COMP","WORKERS COMP CITY OF BOSTON"]
["WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS"]
["WORKERS COMP","WORKERS COMP COVE RISK"]
["WORKERS COMP","WORKERS COMP GALLAGHER BASSETT"]
["WORKERS COMP","WORKERS COMP GUARD INSURANCE"]
["WORKERS COMP","WORKERS COMP LIBERTY MUTUAL"]
["WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS"]
["WORKERS COMP","WORKERS COMP MBTA"]
["WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT"]
["WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS"]
["WORKERS COMP","WORKERS COMP STANDARD"]
["WORKERS COMP","WORKERS COMP THE HARTFORD"]
["WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR"]
["WORKERS COMP","ZZZWORKERS COMP AIG"]
["WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND"]
["WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS"]
["WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT"]
["WORKERS COMP","ZZZWORKERS COMP BROADSPIRE"]
["WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY"]
["ZZZAETNA","ZZZAETNA HMO"]
["ZZZAETNA","ZZZAETNA MCR SUPP"]
["ZZZAETNA","ZZZAETNA POS"]
["ZZZAETNA","ZZZAETNA PPO-EPO"]
["ZZZAETNA","ZZZAETNA STUDENT HEALTH"]
["ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD"]
["ZZZCCA ONECARE","ZZZCCA ONECARE"]
["ZZZCCA ONECARE","ZZZCCA SCO ONECARE"]
["ZZZCIGNA","CIGNA LOCALPLUS"]
["ZZZCIGNA","ZZZCIGNA CARELINK"]
["ZZZCIGNA","ZZZCIGNA STANDARD"]
["ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD"]
["ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD"]
["ZZZUNITED","ZZZUNITED DEFINITY HRA"]
["ZZZUNITED","ZZZUNITED HP SHIP"]
["ZZZUNITED","ZZZUNITED HP STUDENT HEALTH"]
["ZZZUNITED","ZZZUNITED PASSPORT CONNECT"]
["ZZZUNITED","ZZZUNITED STANDARD"]

{"sheet":"PayerPlanCount (HCPCS)","index":25,"n_rows":212,"n_cols":13,"rows_kept":212,"cut":false,"hidden":true,"merged":[[0,0,0,1],[0,8,0,9]]}
["Unique Payer Plan combination",null,null,null,null,null,null,null,"Plan Count per Payer",null,null,null,"Unique Payers"]
["Payer","Plan",null,null,null,null,null,null,"Payer","Count of Plan",null,null,"Payer"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MCR COMPLETE PPO NON CONTRACTED",null,null,null,null,null,null,"CORRECTIONS",42,null,null,"AARP UHC MEDICARE COMPLETE"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE HMO",null,null,null,null,null,null,"WORKERS COMP",23,null,null,"AETNA"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE PPO",null,null,null,null,null,null,"TUFTS CONNCARE/QHP",13,null,null,"AETNA MEDICARE MANAGED"]
["AARP UHC MEDICARE COMPLETE","AARP UHC MEDICARE COMPLETE STANDARD",null,null,null,null,null,null,"BCBS",7,null,null,"BCBS"]
["AETNA","AETNA HMO",null,null,null,null,null,null,"UNITED",6,null,null,"BCBS MEDICARE MANAGED"]
["AETNA","AETNA MCR SUPP",null,null,null,null,null,null,"HARVARD PILGRIM HEALTH CARE",6,null,null,"BCBS OUT OF STATE"]
["AETNA","AETNA POS",null,null,null,null,null,null,"TUFTS",6,null,null,"CCA"]
["AETNA","AETNA PPO EPO",null,null,null,null,null,null,"AETNA",5,null,null,"CCA MEDICARE PREFERRED"]
["AETNA","AETNA STUDENT HEALTH",null,null,null,null,null,null,"UNITED MEDICARE MANAGED",5,null,null,"CIGNA"]
["AETNA MEDICARE MANAGED","AETNA MEDICARE MANAGED STANDARD",null,null,null,null,null,null,"TUFTS MEDICARE MANAGED",5,null,null,"CORRECTIONS"]
["BCBS","BCBS HMO",null,null,null,null,null,null,"ZZZAETNA",5,null,null,"FALLON"]
["BCBS","BCBS INDEMNITY",null,null,null,null,null,null,"ZZZUNITED",5,null,null,"FALLON MEDICARE MANAGED"]
["BCBS","BCBS POS",null,null,null,null,null,null,"FALLON",4,null,null,"FALLON SCO"]
["BCBS","BCBS PPO",null,null,null,null,null,null,"HEALTH PLANS INC",4,null,null,"HARVARD PILGRIM HEALTH CARE"]
["BCBS","BCBS SHIP PPO",null,null,null,null,null,null,"BCBS OUT OF STATE",4,null,null,"HEALTH PLANS INC"]
["BCBS","BCBS STANDARD",null,null,null,null,null,null,"ZZZHEALTH PLANS INC",4,null,null,"HPHC MEDICARE MANAGED"]
["BCBS","BLUE BENEFITS ADMINISTRATORS OF MA",null,null,null,null,null,null,"AARP UHC MEDICARE COMPLETE",4,null,null,"HSN"]
["BCBS MEDICARE MANAGED","BCBS MCR MNG HMO",null,null,null,null,null,null,"MEDICARE",4,null,null,"HSN BAD DEBT"]
["BCBS MEDICARE MANAGED","BCBS MCR MNG PPO",null,null,null,null,null,null,"CIGNA",3,null,null,"HSN CONFIDENTIAL"]
["BCBS OUT OF STATE","BCBS OUT OF STATE HMO",null,null,null,null,null,null,"WELLCARE",3,null,null,"HSN DENTAL"]
["BCBS OUT OF STATE","BCBS OUT OF STATE INDEMNITY",null,null,null,null,null,null,"ZZZCIGNA",3,null,null,"HSN PARTIAL"]
["BCBS OUT OF STATE","BCBS OUT OF STATE POS",null,null,null,null,null,null,"FALLON MEDICARE MANAGED",3,null,null,"HUMANA MEDICARE"]
["BCBS OUT OF STATE","BCBS OUT OF STATE PPO",null,null,null,null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL",3,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL"]
["CCA","CCA SCO ONECARE",null,null,null,null,null,null,"CCA MEDICARE PREFERRED",3,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME"]
["CCA","CCA SCO STANDARD",null,null,null,null,null,null,"CCA",3,null,null,"MEDICARE"]
["CCA","ZZZCCA STANDARD",null,null,null,null,null,null,"TRICARE EAST",2,null,null,"NEIGHBORHOOD PACE"]
["CCA MEDICARE PREFERRED","CCA MEDICARE PREFERRED PPO",null,null,null,null,null,null,"ZZZCCA ONECARE",2,null,null,"OXFORD HEALTH"]
["CCA MEDICARE PREFERRED","CCA MEDICARE VALUE PPO",null,null,null,null,null,null,"BCBS MEDICARE MANAGED",2,null,null,"SENIOR WHOLE HEALTH"]
["CCA MEDICARE PREFERRED","ZZZCCA",null,null,null,null,null,null,"HSN",2,null,null,"TRICARE EAST"]
["CIGNA","CIGNA CARELINK",null,null,null,null,null,null,"SENIOR WHOLE HEALTH",2,null,null,"TRICARE FOR LIFE"]
["CIGNA","CIGNA LOCALPLUS",null,null,null,null,null,null,"WELLSENSE MEDICARE MANAGED",2,null,null,"TUFTS"]
["CIGNA","CIGNA STANDARD",null,null,null,null,null,null,"UNITED COMMUNITY PLAN",2,null,null,"TUFTS CONNCARE/QHP"]
["CORRECTIONS","CORRECTIONS BARNSTABLE COUNTY",null,null,null,null,null,null,"HSN PARTIAL",2,null,null,"TUFTS MEDICARE"]
["CORRECTIONS","CORRECTIONS BRISTOL",null,null,null,null,null,null,"OXFORD HEALTH",2,null,null,"TUFTS MEDICARE MANAGED"]
["CORRECTIONS","CORRECTIONS BRISTOL-N DARTZZZ",null,null,null,null,null,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND",1,null,null,"UBH HPHC"]
["CORRECTIONS","CORRECTIONS DEVENS PROGRAM",null,null,null,null,null,null,"ZZZBU EMPLOYEE WORK COMP",1,null,null,"UNICARE"]
["CORRECTIONS","CORRECTIONS DPT OF YOUTH SVC",null,null,null,null,null,null,"UBH HPHC",1,null,null,"UNITED"]
["CORRECTIONS","CORRECTIONS ESSEX SALISBURY",null,null,null,null,null,null,"UNICARE",1,null,null,"UNITED COMMUNITY PLAN"]
["CORRECTIONS","CORRECTIONS HAMPDEN COUNTY",null,null,null,null,null,null,"HUMANA MEDICARE",1,null,null,"UNITED MEDICARE MANAGED"]
["CORRECTIONS","CORRECTIONS HEALTHCOST SOLUTIONS",null,null,null,null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME",1,null,null,"UPHAMS CORNER ESP"]
["CORRECTIONS","CORRECTIONS ICE INMATE",null,null,null,null,null,null,"ZZZRAILROAD MEDICARE",1,null,null,"WELLCARE"]
["CORRECTIONS","CORRECTIONS MIDDLESEX",null,null,null,null,null,null,"AETNA MEDICARE MANAGED",1,null,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE"]
["CORRECTIONS","CORRECTIONS NAPHCARE",null,null,null,null,null,null,"TRICARE FOR LIFE",1,null,null,"WELLSENSE MEDICARE MANAGED"]
["CORRECTIONS","CORRECTIONS NASHUA",null,null,null,null,null,null,"NEIGHBORHOOD PACE",1,null,null,"WORKERS COMP"]
["CORRECTIONS","CORRECTIONS NORFOLK",null,null,null,null,null,null,"FALLON SCO",1,null,null,"ZZZAETNA"]
["CORRECTIONS","CORRECTIONS NORFOLK CTY CORR",null,null,null,null,null,null,"UPHAMS CORNER ESP",1,null,null,"ZZZBU EMPLOYEE WORK COMP"]
["CORRECTIONS","CORRECTIONS PLYMOUTH",null,null,null,null,null,null,"ZZZCITY OF BOSTON WORK COMP",1,null,null,"ZZZCCA ONECARE"]
["CORRECTIONS","CORRECTIONS PLYMOUTH CORR",null,null,null,null,null,null,"HSN BAD DEBT",1,null,null,"ZZZCIGNA"]
["CORRECTIONS","CORRECTIONS SUFFOLK COUNTY",null,null,null,null,null,null,"TUFTS MEDICARE",1,null,null,"ZZZCITY OF BOSTON WORK COMP"]
["CORRECTIONS","ZZZCORRECTIONS BAY STATE",null,null,null,null,null,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE",1,null,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND"]
["CORRECTIONS","ZZZCORRECTIONS BOSTON PRE-REL",null,null,null,null,null,null,"HPHC MEDICARE MANAGED",1,null,null,"ZZZHEALTH PLANS INC"]
["CORRECTIONS","ZZZCORRECTIONS BRADSTON",null,null,null,null,null,null,"HSN CONFIDENTIAL",1,null,null,"ZZZRAILROAD MEDICARE"]
["CORRECTIONS","ZZZCORRECTIONS BRIDGEWATER ST",null,null,null,null,null,null,"HSN DENTAL",1,null,null,"ZZZUNITED"]
["CORRECTIONS","ZZZCORRECTIONS BRISTOL-NEW BED",null,null,null,null,null,null,"Grand Total",210]
["CORRECTIONS","ZZZCORRECTIONS CEDAR"]
["CORRECTIONS","ZZZCORRECTIONS CONCORD"]
["CORRECTIONS","ZZZCORRECTIONS ESSEX MIDDLETON"]
["CORRECTIONS","ZZZCORRECTIONS GARDNER"]
["CORRECTIONS","ZZZCORRECTIONS LEMUEL SHATTUCK"]
["CORRECTIONS","ZZZCORRECTIONS MASS ALCOHOL"]
["CORRECTIONS","ZZZCORRECTIONS MASS TREAT CTR"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX BILL"]
["CORRECTIONS","ZZZCORRECTIONS MIDDLESEX CAMB"]
["CORRECTIONS","ZZZCORRECTIONS N CENTRAL CORR"]
["CORRECTIONS","ZZZCORRECTIONS NASHUA"]
["CORRECTIONS","ZZZCORRECTIONS NORFOLK"]
["CORRECTIONS","ZZZCORRECTIONS NORTHEAST CORR"]
["CORRECTIONS","ZZZCORRECTIONS OLD COLONY"]
["CORRECTIONS","ZZZCORRECTIONS PLYMOUTH"]
["CORRECTIONS","ZZZCORRECTIONS PONDVILLE"]
["CORRECTIONS","ZZZCORRECTIONS S MIDDLESEX CORR"]
["CORRECTIONS","ZZZCORRECTIONS SHIRLEY"]
["CORRECTIONS","ZZZCORRECTIONS SOUZA BARANOWSKI"]
["CORRECTIONS","ZZZORRECTIONS FRAMINGHAM"]
["FALLON","FALLON COMMUNITY PLAN"]
["FALLON","FALLON HMO STANDARD"]
["FALLON","FALLON POS STANDARD"]
["FALLON","FALLON PPO STANDARD"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG POS"]
["FALLON MEDICARE MANAGED","FALLON MCG MNG PPO"]
["FALLON MEDICARE MANAGED","FALLON MCR MNG HMO"]
["FALLON SCO","FALLON SCO HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE CHOICE PLUS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE HMO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE INDEMNITY"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE POS"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE PPO"]
["HARVARD PILGRIM HEALTH CARE","HARVARD PILGRIM HEALTH CARE SHIP"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC PPO"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC SELECT"]
["HEALTH PLANS INC","HEALTH PLANS INC BMC TIERED HMO"]
["HEALTH PLANS INC","HEALTH PLANS INC STANDARD"]
["HPHC MEDICARE MANAGED","HARVARD PILGRIM MEDICARE ADV STRIDE"]
["HSN","HSN STANDARD"]
["HSN","HSN TEMPORARY"]
["HSN BAD DEBT","HSN BAD DEBT"]
["HSN CONFIDENTIAL","HSN CONFIDENTIAL"]
["HSN DENTAL","HSN DENTAL"]
["HSN PARTIAL","HSN PARTIAL STANDARD"]
["HSN PARTIAL","HSN PARTIAL TEMPORARY"]
["HUMANA MEDICARE","HUMANA MEDICARE STANDARD"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIG COMMERCIAL EPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMECIAL HMO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM COMMERCIAL PPO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MASS GEN BRIG HLTHPLAN PPO"]
["MEDICARE","MEDICARE A&B"]
["MEDICARE","MEDICARE PART A ONLY"]
["MEDICARE","MEDICARE PART B ONLY"]
["MEDICARE","RAILROAD MEDICARE  RAILROAD"]
["NEIGHBORHOOD PACE","NEIGHBORHOOD PACE STANDARD"]
["OXFORD HEALTH","OXFORD HEALTH STANDARD"]
["OXFORD HEALTH","ZZZOXFORD HEALTH STANDARD"]
["SENIOR WHOLE HEALTH","SENIOR WHOLE HEALTH SCO STANDARD"]
["SENIOR WHOLE HEALTH","ZZZSENIOR WHOLE HEALTH STANDARD"]
["TRICARE EAST","TRICARE EAST PRIME (HMO)"]
["TRICARE EAST","TRICARE EAST SELECT"]
["TRICARE FOR LIFE","TRICARE FOR LIFE"]
["TUFTS","TUFTS CARELINK"]
["TUFTS","TUFTS HMO"]
["TUFTS","TUFTS POS"]
["TUFTS","TUFTS PPO"]
["TUFTS","TUFTS SELECT"]
["TUFTS","TUFTS SPIRIT"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 1"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHP CONCRE TYP 3"]
["TUFTS CONNCARE/QHP","TUFTS CONNCARE QHPCONCRE TYP 2"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP BRONZE SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP GOLD SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP PLATINUM SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP SILVER SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD NON SUBSIDIZED"]
["TUFTS CONNCARE/QHP","TUFTS QHP STANDARD SUBSIDIZED"]
["TUFTS MEDICARE","TUFTS MEDICARE HMO"]
["TUFTS MEDICARE MANAGED","TUFTS MCR MNG POS"]
["TUFTS MEDICARE MANAGED","TUFTS SCO MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS MCR MNG ONECARE"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG HMO"]
["TUFTS MEDICARE MANAGED","ZZZTUFTS SCO MCR MNG POS"]
["UBH HPHC","UBH HPHC"]
["UNICARE","UNICARE STANDARD"]
["UNITED","UNITED DEFINITY HRA"]
["UNITED","UNITED HP SHIP"]
["UNITED","UNITED HP STUDENT HEALTH"]
["UNITED","UNITED NAVIGATE"]
["UNITED","UNITED PASSPORT CONNECT"]
["UNITED","UNITED STANDARD"]
["UNITED COMMUNITY PLAN","UHC COMMUNITY SCO HMO"]
["UNITED COMMUNITY PLAN","ZZZUHC COMMUNITY PLAN STANDARD"]
["UNITED MEDICARE MANAGED","UNITED MA MMP ONECARE"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG HMO"]
["UNITED MEDICARE MANAGED","UNITED MCR MNG PPO"]
["UNITED MEDICARE MANAGED","UNITED SCO MCR MNG PPO"]
["UNITED MEDICARE MANAGED","ZZZUNITED SCO MCR MNG HMO"]
["UPHAMS CORNER ESP","UPHAMS CORNER ESP STANDARD"]
["WELLCARE","WELLCARE HMO"]
["WELLCARE","WELLCARE PPO"]
["WELLCARE","WELLCARE STANDARD"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICAID NEW HAMPSHIRE STANDRD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE MCR MNG STANDARD"]
["WELLSENSE MEDICARE MANAGED","WELLSENSE SCO/SENIOR CARE OPTIONS"]
["WORKERS COMP","WORKERS COMP AIM MUTUAL C/O CORVEL CORP"]
["WORKERS COMP","WORKERS COMP ATLANTIC CHARTER INSURANCE"]
["WORKERS COMP","WORKERS COMP BOSTON POLICE DEPARTMENT"]
["WORKERS COMP","WORKERS COMP CCMSI"]
["WORKERS COMP","WORKERS COMP CITY OF BOSTON"]
["WORKERS COMP","WORKERS COMP COMMONWEALTH OF MASS"]
["WORKERS COMP","WORKERS COMP COVE RISK"]
["WORKERS COMP","WORKERS COMP GALLAGHER BASSETT"]
["WORKERS COMP","WORKERS COMP GUARD INSURANCE"]
["WORKERS COMP","WORKERS COMP LIBERTY MUTUAL"]
["WORKERS COMP","WORKERS COMP MASS BAYSTATE SELF INS"]
["WORKERS COMP","WORKERS COMP MBTA"]
["WORKERS COMP","WORKERS COMP SEDGWICK CLAIMS MANAGEMENT"]
["WORKERS COMP","WORKERS COMP ST PAUL TRAVELERS INS"]
["WORKERS COMP","WORKERS COMP STANDARD"]
["WORKERS COMP","WORKERS COMP THE HARTFORD"]
["WORKERS COMP","WORKERS COMP US DEPARTMENT OF LABOR"]
["WORKERS COMP","ZZZWORKERS COMP AIG"]
["WORKERS COMP","ZZZWORKERS COMP AMTRUST NEW ENGLAND"]
["WORKERS COMP","ZZZWORKERS COMP ATLANTIC CHARTER INS"]
["WORKERS COMP","ZZZWORKERS COMP BOSTON FIRE DEPARTMENT"]
["WORKERS COMP","ZZZWORKERS COMP BROADSPIRE"]
["WORKERS COMP","ZZZWORKERS COMP COOK AND COMPANY"]
["ZZZAETNA","ZZZAETNA HMO"]
["ZZZAETNA","ZZZAETNA MCR SUPP"]
["ZZZAETNA","ZZZAETNA POS"]
["ZZZAETNA","ZZZAETNA PPO-EPO"]
["ZZZAETNA","ZZZAETNA STUDENT HEALTH"]
["ZZZBU EMPLOYEE WORK COMP","ZZZBU EMPLOYEE WORK COMP STANDARD"]
["ZZZCCA ONECARE","ZZZCCA ONECARE"]
["ZZZCCA ONECARE","ZZZCCA SCO ONECARE"]
["ZZZCIGNA","CIGNA LOCALPLUS"]
["ZZZCIGNA","ZZZCIGNA CARELINK"]
["ZZZCIGNA","ZZZCIGNA STANDARD"]
["ZZZCITY OF BOSTON WORK COMP","ZZZCITY OF BOSTON WORK COMP"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","COVID19 HRSA UNINSURED TREATMENT FUND"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC PPO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC SELECT"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC BMC TIERED HMO"]
["ZZZHEALTH PLANS INC","ZZZHEALTH PLANS INC STANDARD"]
["ZZZRAILROAD MEDICARE","ZZZRAILROAD MEDICARE  RAILROAD"]
["ZZZUNITED","ZZZUNITED DEFINITY HRA"]
["ZZZUNITED","ZZZUNITED HP SHIP"]
["ZZZUNITED","ZZZUNITED HP STUDENT HEALTH"]
["ZZZUNITED","ZZZUNITED PASSPORT CONNECT"]
["ZZZUNITED","ZZZUNITED STANDARD"]

{"sheet":"HCPCSPayerPlan Pivot","index":26,"n_rows":57,"n_cols":2,"rows_kept":57,"cut":false,"hidden":true,"merged":[]}
[]
[]
["Row Labels","Count of HCPCS & Description"]
["UNICARE",40]
["ZZZCITY OF BOSTON WORK COMP",40]
["WORKERS COMP",40]
["AETNA",40]
["TUFTS",40]
["BCBS",40]
["UPHAMS CORNER ESP",40]
["BCBS OUT OF STATE",40]
["ZZZBU EMPLOYEE WORK COMP",40]
["CIGNA",40]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME",40]
["FALLON",40]
["TUFTS CONNCARE/QHP",40]
["HSN",40]
["UNITED",40]
["HSN BAD DEBT",40]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE",40]
["HSN CONFIDENTIAL",40]
["ZZZAETNA",40]
["HSN DENTAL",40]
["ZZZCIGNA",40]
["HSN PARTIAL",40]
["ZZZUNITED",40]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL",40]
["HARVARD PILGRIM HEALTH CARE",38]
["ZZZHEALTH PLANS INC",38]
["HEALTH PLANS INC",38]
["OXFORD HEALTH",35]
["HUMANA MEDICARE",34]
["ZZZRAILROAD MEDICARE",34]
["MEDICARE",34]
["TRICARE FOR LIFE",34]
["FALLON SCO",34]
["HPHC MEDICARE MANAGED",34]
["CCA MEDICARE PREFERRED",34]
["BCBS MEDICARE MANAGED",34]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND",34]
["TUFTS MEDICARE",34]
["TRICARE EAST",34]
["TUFTS MEDICARE MANAGED",34]
["WELLSENSE MEDICARE MANAGED",34]
["UBH HPHC",34]
["CCA",34]
["CORRECTIONS",34]
["ZZZCCA ONECARE",34]
["AETNA MEDICARE MANAGED",34]
["NEIGHBORHOOD PACE",34]
["UNITED COMMUNITY PLAN",34]
["AARP UHC MEDICARE COMPLETE",34]
["UNITED MEDICARE MANAGED",34]
["SENIOR WHOLE HEALTH",34]
["FALLON MEDICARE MANAGED",34]
["WELLCARE",34]
["Grand Total",1959]

{"sheet":"HCPCSPayer&Code&Desc","index":27,"n_rows":1960,"n_cols":57,"rows_kept":1960,"cut":false,"hidden":true,"merged":[]}
["Payer","HCPCS & Description",null,"Select Insurance Carrier","AARP UHC MEDICARE COMPLETE","AETNA","AETNA MEDICARE MANAGED","BCBS","BCBS MEDICARE MANAGED","BCBS OUT OF STATE","CCA","CCA MEDICARE PREFERRED","CIGNA","CORRECTIONS","FALLON","FALLON MEDICARE MANAGED","FALLON SCO","HARVARD PILGRIM HEALTH CARE","HEALTH PLANS INC","HPHC MEDICARE MANAGED","HSN","HSN BAD DEBT","HSN CONFIDENTIAL","HSN DENTAL","HSN PARTIAL","HUMANA MEDICARE","MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","MASS GENERAL BRIGHAM HEALTH PLAN PRIME","MEDICARE","NEIGHBORHOOD PACE","OXFORD HEALTH","SENIOR WHOLE HEALTH","TRICARE EAST","TRICARE FOR LIFE","TUFTS","TUFTS CONNCARE/QHP","TUFTS MEDICARE","TUFTS MEDICARE MANAGED","UBH HPHC","UNICARE","UNITED","UNITED COMMUNITY PLAN","UNITED MEDICARE MANAGED","UPHAMS CORNER ESP","WELLCARE","WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","WELLSENSE MEDICARE MANAGED","WORKERS COMP","ZZZAETNA","ZZZBU EMPLOYEE WORK COMP","ZZZCCA ONECARE","ZZZCIGNA","ZZZCITY OF BOSTON WORK COMP","ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","ZZZHEALTH PLANS INC","ZZZRAILROAD MEDICARE","ZZZUNITED"]
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INJ PROHANCE MULTIPACK"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"A9576 - INJ PROHANCE MULTIPACK"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"A9576 - INJ PROHANCE MULTIPACK"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"A9576 - INJ PROHANCE MULTIPACK"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"A9576 - INJ PROHANCE MULTIPACK"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"A9576 - INJ PROHANCE MULTIPACK"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"A9576 - INJ PROHANCE MULTIPACK"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(1:1))),\"\" )","v":"A9576 - 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PR BEVACIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"C9257 - PR BEVACIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"C9257 - PR BEVACIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"C9257 - PR BEVACIZUMAB INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(3:3))),\"\" )","v":"C9257 - PR BEVACIZUMAB INJECTION"}]
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PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(4:4))),\"\" )","v":"J0131 - PR ACETAMINOPHEN INJECTION"}]
["AARP UHC MEDICARE COMPLETE","J0583 - PR BIVALIRUDIN",null,null,{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(E$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(F$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(G$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(H$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(I$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(J$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(K$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(5:5))),\"\" )","v":"J0137 - 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PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(13:13))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(13:13))),\"\" )","v":"J1250 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(13:13))),\"\" )","v":"J1250 - PR INJ DOBUTAMINE HCL/250 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(13:13))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(13:13))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(13:13))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(13:13))),\"\" )","v":"J1580 - 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PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - PR GAMUNEX-C/GAMMAKED"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(14:14))),\"\" )","v":"J1561 - 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PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(K$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - 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PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - PR GARAMYCIN GENTAMICIN INJ"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(15:15))),\"\" )","v":"J1580 - 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PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - 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PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(16:16))),\"\" )","v":"J1815 - PR INSULIN INJECTION"}]
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PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1953 - 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PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(17:17))),\"\" )","v":"J1817 - PR INSULIN FOR INSULIN PUMP USE"}]
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PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(K$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - PR LEVETIRACETAM INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(18:18))),\"\" )","v":"J1953 - 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PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(19:19))),\"\" )","v":"J2001 - PR LIDOCAINE INJECTION"}]
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PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - 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PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - 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PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(20:20))),\"\" )","v":"J2270 - PR MORPHINE SULFATE INJECTION"}]
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PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2598 - PR INJ, VASOPRESSIN, 1 UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2704 - PR INJ, PROPFOL, 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - PR INJ NALOXONE HYDROCHLORIDE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(21:21))),\"\" )","v":"J2310 - 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PR 5% DEXTROSE IN LAC RINGERS"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J7121 - PR 5% DEXTROSE IN LAC RINGERS"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J7121 - PR 5% DEXTROSE IN LAC RINGERS"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J9041 - 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PR 5% DEXTROSE IN LAC RINGERS"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(30:30))),\"\" )","v":"J7121 - PR 5% DEXTROSE IN LAC RINGERS"}]
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PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - 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PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7307 - ETONOGESTREL IMPLANT SYSTEM"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(31:31))),\"\" )","v":"J7131 - PR HYPERTONIC SALINE SOL"}]
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ACETYLCYSTEINE NON-COMP UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7608 - ACETYLCYSTEINE NON-COMP UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - ETONOGESTREL IMPLANT SYSTEM"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - ETONOGESTREL IMPLANT SYSTEM"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - ETONOGESTREL IMPLANT SYSTEM"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - ETONOGESTREL IMPLANT SYSTEM"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - 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PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - ETONOGESTREL IMPLANT SYSTEM"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - ETONOGESTREL IMPLANT SYSTEM"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - ETONOGESTREL IMPLANT SYSTEM"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(32:32))),\"\" )","v":"J7307 - 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ACETYLCYSTEINE NON-COMP UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"J7608 - ACETYLCYSTEINE NON-COMP UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"J7608 - ACETYLCYSTEINE NON-COMP UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"J7608 - ACETYLCYSTEINE NON-COMP UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"Q5114 - 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ACETYLCYSTEINE NON-COMP UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"J7608 - ACETYLCYSTEINE NON-COMP UNIT"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(33:33))),\"\" )","v":"J7608 - ACETYLCYSTEINE NON-COMP UNIT"}]
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PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(34:34))),\"\" )","v":"J8540 - PR ORAL DEXAMETHASONE"}]
["AETNA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",null,null,{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(E$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(F$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(G$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(H$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(I$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(J$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(K$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(35:35))),\"\" )","v":"J9041 - PR INJ., VELCADE 0.1 MG"}]
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PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(36:36))),\"\" )","v":"P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"}]
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TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - 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TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - TOCILIZUMAB FOR COVID-19"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(37:37))),\"\" )","v":"Q0249 - 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PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(38:38))),\"\" )","v":"Q5114 - PR INJ OGIVRI 10 MG"}]
["AETNA","J0583 - PR BIVALIRUDIN",null,null,{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(E$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(F$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(G$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(H$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(I$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(J$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(K$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(39:39))),\"\" )","v":"Q9967 - LOCM 300-399MG/ML IODINE,1ML"}]
["AETNA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",null,null,{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(E$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(F$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(G$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(H$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(I$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(J$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(K$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(L$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(M$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(N$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(O$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(P$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Q$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(R$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(S$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(T$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(U$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(V$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(W$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(X$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Y$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(Z$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AF$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AG$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AH$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AI$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AJ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AK$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AL$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AM$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AN$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AO$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AP$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AQ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AR$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AS$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AT$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AU$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AV$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AW$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AX$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AY$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(AZ$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BA$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BB$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BC$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BD$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":""},{"$f":"IFERROR(INDEX($B$2:$B$1960, SMALL(IF(BE$1=$A$2:$A$1960, ROW($A$2:$A$1960)-ROW($A$2)+1), ROW(40:40))),\"\" )","v":"S0020 - PR INJECTION, BUPIVICAINE HYDRO"}]
["AETNA","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["AETNA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["AETNA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["AETNA","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["AETNA","J1170 - PR HYDROMORPHONE INJECTION"]
["AETNA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["AETNA","J1561 - PR GAMUNEX-C/GAMMAKED"]
["AETNA","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["AETNA","J1815 - PR INSULIN INJECTION"]
["AETNA","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["AETNA","J1953 - PR LEVETIRACETAM INJECTION"]
["AETNA","J2001 - PR LIDOCAINE INJECTION"]
["AETNA","J2270 - PR MORPHINE SULFATE INJECTION"]
["AETNA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["AETNA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["AETNA","J2704 - PR INJ, PROPFOL, 10 MG"]
["AETNA","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["AETNA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["AETNA","J3010 - PR FENTANYL CITRATE INJECITON"]
["AETNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AETNA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["AETNA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["AETNA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["AETNA","J7131 - PR HYPERTONIC SALINE SOL"]
["AETNA","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["AETNA","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["AETNA","J8540 - PR ORAL DEXAMETHASONE"]
["AETNA","J9041 - PR INJ., VELCADE 0.1 MG"]
["AETNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AETNA","Q0249 - TOCILIZUMAB FOR COVID-19"]
["AETNA","Q5114 - PR INJ OGIVRI 10 MG"]
["AETNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["AETNA","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["AETNA MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["AETNA MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["AETNA MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["AETNA MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["AETNA MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["AETNA MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["AETNA MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["AETNA MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["AETNA MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["AETNA MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["AETNA MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["AETNA MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["AETNA MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["AETNA MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["AETNA MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["AETNA MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["AETNA MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["AETNA MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["AETNA MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["AETNA MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["AETNA MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["AETNA MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["AETNA MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["AETNA MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AETNA MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["AETNA MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["AETNA MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["AETNA MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["AETNA MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["AETNA MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["AETNA MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AETNA MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["AETNA MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["AETNA MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["BCBS","A9576 - INJ PROHANCE MULTIPACK"]
["BCBS","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["BCBS","C9257 - PR BEVACIZUMAB INJECTION"]
["BCBS","J0131 - PR ACETAMINOPHEN INJECTION"]
["BCBS","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["BCBS","J0583 - PR BIVALIRUDIN"]
["BCBS","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["BCBS","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["BCBS","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["BCBS","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["BCBS","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["BCBS","J1170 - PR HYDROMORPHONE INJECTION"]
["BCBS","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["BCBS","J1561 - PR GAMUNEX-C/GAMMAKED"]
["BCBS","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["BCBS","J1815 - PR INSULIN INJECTION"]
["BCBS","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["BCBS","J1953 - PR LEVETIRACETAM INJECTION"]
["BCBS","J2001 - PR LIDOCAINE INJECTION"]
["BCBS","J2270 - PR MORPHINE SULFATE INJECTION"]
["BCBS","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["BCBS","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["BCBS","J2704 - PR INJ, PROPFOL, 10 MG"]
["BCBS","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["BCBS","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["BCBS","J3010 - PR FENTANYL CITRATE INJECITON"]
["BCBS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["BCBS","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["BCBS","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["BCBS","J7131 - PR HYPERTONIC SALINE SOL"]
["BCBS","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["BCBS","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["BCBS","J8540 - PR ORAL DEXAMETHASONE"]
["BCBS","J9041 - PR INJ., VELCADE 0.1 MG"]
["BCBS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS","Q0249 - TOCILIZUMAB FOR COVID-19"]
["BCBS","Q5114 - PR INJ OGIVRI 10 MG"]
["BCBS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["BCBS MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["BCBS MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["BCBS MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["BCBS MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["BCBS MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["BCBS MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["BCBS MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["BCBS MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["BCBS MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["BCBS MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["BCBS MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["BCBS MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["BCBS MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["BCBS MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["BCBS MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["BCBS MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["BCBS MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["BCBS MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["BCBS MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["BCBS MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["BCBS MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["BCBS MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["BCBS MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["BCBS MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["BCBS MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["BCBS MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["BCBS MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["BCBS MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["BCBS MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["BCBS MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["BCBS MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["BCBS OUT OF STATE","A9576 - INJ PROHANCE MULTIPACK"]
["BCBS OUT OF STATE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["BCBS OUT OF STATE","C9257 - PR BEVACIZUMAB INJECTION"]
["BCBS OUT OF STATE","J0131 - PR ACETAMINOPHEN INJECTION"]
["BCBS OUT OF STATE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["BCBS OUT OF STATE","J0583 - PR BIVALIRUDIN"]
["BCBS OUT OF STATE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["BCBS OUT OF STATE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["BCBS OUT OF STATE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["BCBS OUT OF STATE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["BCBS OUT OF STATE","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["BCBS OUT OF STATE","J1170 - PR HYDROMORPHONE INJECTION"]
["BCBS OUT OF STATE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["BCBS OUT OF STATE","J1561 - PR GAMUNEX-C/GAMMAKED"]
["BCBS OUT OF STATE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["BCBS OUT OF STATE","J1815 - PR INSULIN INJECTION"]
["BCBS OUT OF STATE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["BCBS OUT OF STATE","J1953 - PR LEVETIRACETAM INJECTION"]
["BCBS OUT OF STATE","J2001 - PR LIDOCAINE INJECTION"]
["BCBS OUT OF STATE","J2270 - PR MORPHINE SULFATE INJECTION"]
["BCBS OUT OF STATE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["BCBS OUT OF STATE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["BCBS OUT OF STATE","J2704 - PR INJ, PROPFOL, 10 MG"]
["BCBS OUT OF STATE","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["BCBS OUT OF STATE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["BCBS OUT OF STATE","J3010 - PR FENTANYL CITRATE INJECITON"]
["BCBS OUT OF STATE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS OUT OF STATE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["BCBS OUT OF STATE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["BCBS OUT OF STATE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["BCBS OUT OF STATE","J7131 - PR HYPERTONIC SALINE SOL"]
["BCBS OUT OF STATE","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["BCBS OUT OF STATE","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["BCBS OUT OF STATE","J8540 - PR ORAL DEXAMETHASONE"]
["BCBS OUT OF STATE","J9041 - PR INJ., VELCADE 0.1 MG"]
["BCBS OUT OF STATE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS OUT OF STATE","Q0249 - TOCILIZUMAB FOR COVID-19"]
["BCBS OUT OF STATE","Q5114 - PR INJ OGIVRI 10 MG"]
["BCBS OUT OF STATE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["BCBS OUT OF STATE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["CCA","A9576 - INJ PROHANCE MULTIPACK"]
["CCA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["CCA","C9257 - PR BEVACIZUMAB INJECTION"]
["CCA","J0131 - PR ACETAMINOPHEN INJECTION"]
["CCA","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["CCA","J0583 - PR BIVALIRUDIN"]
["CCA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["CCA","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["CCA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["CCA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["CCA","J1170 - PR HYDROMORPHONE INJECTION"]
["CCA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["CCA","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["CCA","J1815 - PR INSULIN INJECTION"]
["CCA","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["CCA","J1953 - PR LEVETIRACETAM INJECTION"]
["CCA","J2001 - PR LIDOCAINE INJECTION"]
["CCA","J2270 - PR MORPHINE SULFATE INJECTION"]
["CCA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["CCA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["CCA","J2704 - PR INJ, PROPFOL, 10 MG"]
["CCA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["CCA","J3010 - PR FENTANYL CITRATE INJECITON"]
["CCA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["CCA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["CCA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["CCA","J7131 - PR HYPERTONIC SALINE SOL"]
["CCA","J8540 - PR ORAL DEXAMETHASONE"]
["CCA","J9041 - PR INJ., VELCADE 0.1 MG"]
["CCA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CCA","Q5114 - PR INJ OGIVRI 10 MG"]
["CCA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CCA","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["CCA MEDICARE PREFERRED","A9576 - INJ PROHANCE MULTIPACK"]
["CCA MEDICARE PREFERRED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["CCA MEDICARE PREFERRED","C9257 - PR BEVACIZUMAB INJECTION"]
["CCA MEDICARE PREFERRED","J0131 - PR ACETAMINOPHEN INJECTION"]
["CCA MEDICARE PREFERRED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["CCA MEDICARE PREFERRED","J0583 - PR BIVALIRUDIN"]
["CCA MEDICARE PREFERRED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["CCA MEDICARE PREFERRED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["CCA MEDICARE PREFERRED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["CCA MEDICARE PREFERRED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["CCA MEDICARE PREFERRED","J1170 - PR HYDROMORPHONE INJECTION"]
["CCA MEDICARE PREFERRED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["CCA MEDICARE PREFERRED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["CCA MEDICARE PREFERRED","J1815 - PR INSULIN INJECTION"]
["CCA MEDICARE PREFERRED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["CCA MEDICARE PREFERRED","J1953 - PR LEVETIRACETAM INJECTION"]
["CCA MEDICARE PREFERRED","J2001 - PR LIDOCAINE INJECTION"]
["CCA MEDICARE PREFERRED","J2270 - PR MORPHINE SULFATE INJECTION"]
["CCA MEDICARE PREFERRED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["CCA MEDICARE PREFERRED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["CCA MEDICARE PREFERRED","J2704 - PR INJ, PROPFOL, 10 MG"]
["CCA MEDICARE PREFERRED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["CCA MEDICARE PREFERRED","J3010 - PR FENTANYL CITRATE INJECITON"]
["CCA MEDICARE PREFERRED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA MEDICARE PREFERRED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["CCA MEDICARE PREFERRED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["CCA MEDICARE PREFERRED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["CCA MEDICARE PREFERRED","J7131 - PR HYPERTONIC SALINE SOL"]
["CCA MEDICARE PREFERRED","J8540 - PR ORAL DEXAMETHASONE"]
["CCA MEDICARE PREFERRED","J9041 - PR INJ., VELCADE 0.1 MG"]
["CCA MEDICARE PREFERRED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CCA MEDICARE PREFERRED","Q5114 - PR INJ OGIVRI 10 MG"]
["CCA MEDICARE PREFERRED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CCA MEDICARE PREFERRED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["CIGNA","A9576 - INJ PROHANCE MULTIPACK"]
["CIGNA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["CIGNA","C9257 - PR BEVACIZUMAB INJECTION"]
["CIGNA","J0131 - PR ACETAMINOPHEN INJECTION"]
["CIGNA","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["CIGNA","J0583 - PR BIVALIRUDIN"]
["CIGNA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["CIGNA","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["CIGNA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["CIGNA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["CIGNA","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["CIGNA","J1170 - PR HYDROMORPHONE INJECTION"]
["CIGNA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["CIGNA","J1561 - PR GAMUNEX-C/GAMMAKED"]
["CIGNA","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["CIGNA","J1815 - PR INSULIN INJECTION"]
["CIGNA","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["CIGNA","J1953 - PR LEVETIRACETAM INJECTION"]
["CIGNA","J2001 - PR LIDOCAINE INJECTION"]
["CIGNA","J2270 - PR MORPHINE SULFATE INJECTION"]
["CIGNA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["CIGNA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["CIGNA","J2704 - PR INJ, PROPFOL, 10 MG"]
["CIGNA","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["CIGNA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["CIGNA","J3010 - PR FENTANYL CITRATE INJECITON"]
["CIGNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CIGNA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["CIGNA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["CIGNA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["CIGNA","J7131 - PR HYPERTONIC SALINE SOL"]
["CIGNA","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["CIGNA","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["CIGNA","J8540 - PR ORAL DEXAMETHASONE"]
["CIGNA","J9041 - PR INJ., VELCADE 0.1 MG"]
["CIGNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CIGNA","Q0249 - TOCILIZUMAB FOR COVID-19"]
["CIGNA","Q5114 - PR INJ OGIVRI 10 MG"]
["CIGNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CIGNA","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["CORRECTIONS","A9576 - INJ PROHANCE MULTIPACK"]
["CORRECTIONS","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["CORRECTIONS","C9257 - PR BEVACIZUMAB INJECTION"]
["CORRECTIONS","J0131 - PR ACETAMINOPHEN INJECTION"]
["CORRECTIONS","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["CORRECTIONS","J0583 - PR BIVALIRUDIN"]
["CORRECTIONS","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["CORRECTIONS","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["CORRECTIONS","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["CORRECTIONS","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["CORRECTIONS","J1170 - PR HYDROMORPHONE INJECTION"]
["CORRECTIONS","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["CORRECTIONS","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["CORRECTIONS","J1815 - PR INSULIN INJECTION"]
["CORRECTIONS","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["CORRECTIONS","J1953 - PR LEVETIRACETAM INJECTION"]
["CORRECTIONS","J2001 - PR LIDOCAINE INJECTION"]
["CORRECTIONS","J2270 - PR MORPHINE SULFATE INJECTION"]
["CORRECTIONS","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["CORRECTIONS","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["CORRECTIONS","J2704 - PR INJ, PROPFOL, 10 MG"]
["CORRECTIONS","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["CORRECTIONS","J3010 - PR FENTANYL CITRATE INJECITON"]
["CORRECTIONS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CORRECTIONS","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["CORRECTIONS","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["CORRECTIONS","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["CORRECTIONS","J7131 - PR HYPERTONIC SALINE SOL"]
["CORRECTIONS","J8540 - PR ORAL DEXAMETHASONE"]
["CORRECTIONS","J9041 - PR INJ., VELCADE 0.1 MG"]
["CORRECTIONS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CORRECTIONS","Q5114 - PR INJ OGIVRI 10 MG"]
["CORRECTIONS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CORRECTIONS","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["FALLON","A9576 - INJ PROHANCE MULTIPACK"]
["FALLON","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["FALLON","C9257 - PR BEVACIZUMAB INJECTION"]
["FALLON","J0131 - PR ACETAMINOPHEN INJECTION"]
["FALLON","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["FALLON","J0583 - PR BIVALIRUDIN"]
["FALLON","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["FALLON","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["FALLON","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["FALLON","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["FALLON","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["FALLON","J1170 - PR HYDROMORPHONE INJECTION"]
["FALLON","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["FALLON","J1561 - PR GAMUNEX-C/GAMMAKED"]
["FALLON","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["FALLON","J1815 - PR INSULIN INJECTION"]
["FALLON","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["FALLON","J1953 - PR LEVETIRACETAM INJECTION"]
["FALLON","J2001 - PR LIDOCAINE INJECTION"]
["FALLON","J2270 - PR MORPHINE SULFATE INJECTION"]
["FALLON","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["FALLON","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["FALLON","J2704 - PR INJ, PROPFOL, 10 MG"]
["FALLON","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["FALLON","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["FALLON","J3010 - PR FENTANYL CITRATE INJECITON"]
["FALLON","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["FALLON","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["FALLON","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["FALLON","J7131 - PR HYPERTONIC SALINE SOL"]
["FALLON","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["FALLON","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["FALLON","J8540 - PR ORAL DEXAMETHASONE"]
["FALLON","J9041 - PR INJ., VELCADE 0.1 MG"]
["FALLON","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON","Q0249 - TOCILIZUMAB FOR COVID-19"]
["FALLON","Q5114 - PR INJ OGIVRI 10 MG"]
["FALLON","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["FALLON MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["FALLON MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["FALLON MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["FALLON MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["FALLON MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["FALLON MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["FALLON MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["FALLON MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["FALLON MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["FALLON MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["FALLON MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["FALLON MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["FALLON MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["FALLON MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["FALLON MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["FALLON MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["FALLON MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["FALLON MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["FALLON MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["FALLON MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["FALLON MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["FALLON MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["FALLON MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["FALLON MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["FALLON MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["FALLON MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["FALLON MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["FALLON MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["FALLON MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["FALLON MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["FALLON MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["FALLON SCO","A9576 - INJ PROHANCE MULTIPACK"]
["FALLON SCO","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["FALLON SCO","C9257 - PR BEVACIZUMAB INJECTION"]
["FALLON SCO","J0131 - PR ACETAMINOPHEN INJECTION"]
["FALLON SCO","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["FALLON SCO","J0583 - PR BIVALIRUDIN"]
["FALLON SCO","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["FALLON SCO","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["FALLON SCO","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["FALLON SCO","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["FALLON SCO","J1170 - PR HYDROMORPHONE INJECTION"]
["FALLON SCO","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["FALLON SCO","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["FALLON SCO","J1815 - PR INSULIN INJECTION"]
["FALLON SCO","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["FALLON SCO","J1953 - PR LEVETIRACETAM INJECTION"]
["FALLON SCO","J2001 - PR LIDOCAINE INJECTION"]
["FALLON SCO","J2270 - PR MORPHINE SULFATE INJECTION"]
["FALLON SCO","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["FALLON SCO","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["FALLON SCO","J2704 - PR INJ, PROPFOL, 10 MG"]
["FALLON SCO","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["FALLON SCO","J3010 - PR FENTANYL CITRATE INJECITON"]
["FALLON SCO","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON SCO","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["FALLON SCO","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["FALLON SCO","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["FALLON SCO","J7131 - PR HYPERTONIC SALINE SOL"]
["FALLON SCO","J8540 - PR ORAL DEXAMETHASONE"]
["FALLON SCO","J9041 - PR INJ., VELCADE 0.1 MG"]
["FALLON SCO","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON SCO","Q5114 - PR INJ OGIVRI 10 MG"]
["FALLON SCO","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON SCO","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HARVARD PILGRIM HEALTH CARE","A9576 - INJ PROHANCE MULTIPACK"]
["HARVARD PILGRIM HEALTH CARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HARVARD PILGRIM HEALTH CARE","C9257 - PR BEVACIZUMAB INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HARVARD PILGRIM HEALTH CARE","J0583 - PR BIVALIRUDIN"]
["HARVARD PILGRIM HEALTH CARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HARVARD PILGRIM HEALTH CARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HARVARD PILGRIM HEALTH CARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HARVARD PILGRIM HEALTH CARE","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HARVARD PILGRIM HEALTH CARE","J1170 - PR HYDROMORPHONE INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HARVARD PILGRIM HEALTH CARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HARVARD PILGRIM HEALTH CARE","J1815 - PR INSULIN INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HARVARD PILGRIM HEALTH CARE","J1953 - PR LEVETIRACETAM INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J2001 - PR LIDOCAINE INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HARVARD PILGRIM HEALTH CARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HARVARD PILGRIM HEALTH CARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["HARVARD PILGRIM HEALTH CARE","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HARVARD PILGRIM HEALTH CARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["HARVARD PILGRIM HEALTH CARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HARVARD PILGRIM HEALTH CARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HARVARD PILGRIM HEALTH CARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HARVARD PILGRIM HEALTH CARE","J7131 - PR HYPERTONIC SALINE SOL"]
["HARVARD PILGRIM HEALTH CARE","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HARVARD PILGRIM HEALTH CARE","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HARVARD PILGRIM HEALTH CARE","J8540 - PR ORAL DEXAMETHASONE"]
["HARVARD PILGRIM HEALTH CARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["HARVARD PILGRIM HEALTH CARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HARVARD PILGRIM HEALTH CARE","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HARVARD PILGRIM HEALTH CARE","Q5114 - PR INJ OGIVRI 10 MG"]
["HARVARD PILGRIM HEALTH CARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HEALTH PLANS INC","A9576 - INJ PROHANCE MULTIPACK"]
["HEALTH PLANS INC","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HEALTH PLANS INC","C9257 - PR BEVACIZUMAB INJECTION"]
["HEALTH PLANS INC","J0131 - PR ACETAMINOPHEN INJECTION"]
["HEALTH PLANS INC","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HEALTH PLANS INC","J0583 - PR BIVALIRUDIN"]
["HEALTH PLANS INC","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HEALTH PLANS INC","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HEALTH PLANS INC","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HEALTH PLANS INC","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HEALTH PLANS INC","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HEALTH PLANS INC","J1170 - PR HYDROMORPHONE INJECTION"]
["HEALTH PLANS INC","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HEALTH PLANS INC","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HEALTH PLANS INC","J1815 - PR INSULIN INJECTION"]
["HEALTH PLANS INC","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HEALTH PLANS INC","J1953 - PR LEVETIRACETAM INJECTION"]
["HEALTH PLANS INC","J2001 - PR LIDOCAINE INJECTION"]
["HEALTH PLANS INC","J2270 - PR MORPHINE SULFATE INJECTION"]
["HEALTH PLANS INC","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HEALTH PLANS INC","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HEALTH PLANS INC","J2704 - PR INJ, PROPFOL, 10 MG"]
["HEALTH PLANS INC","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HEALTH PLANS INC","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HEALTH PLANS INC","J3010 - PR FENTANYL CITRATE INJECITON"]
["HEALTH PLANS INC","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HEALTH PLANS INC","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HEALTH PLANS INC","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HEALTH PLANS INC","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HEALTH PLANS INC","J7131 - PR HYPERTONIC SALINE SOL"]
["HEALTH PLANS INC","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HEALTH PLANS INC","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HEALTH PLANS INC","J8540 - PR ORAL DEXAMETHASONE"]
["HEALTH PLANS INC","J9041 - PR INJ., VELCADE 0.1 MG"]
["HEALTH PLANS INC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HEALTH PLANS INC","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HEALTH PLANS INC","Q5114 - PR INJ OGIVRI 10 MG"]
["HEALTH PLANS INC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HPHC MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["HPHC MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HPHC MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["HPHC MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["HPHC MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HPHC MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["HPHC MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HPHC MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HPHC MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HPHC MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HPHC MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["HPHC MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HPHC MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HPHC MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["HPHC MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HPHC MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["HPHC MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["HPHC MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["HPHC MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HPHC MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HPHC MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["HPHC MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HPHC MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["HPHC MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HPHC MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HPHC MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HPHC MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HPHC MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["HPHC MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["HPHC MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["HPHC MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HPHC MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["HPHC MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HPHC MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN","A9576 - INJ PROHANCE MULTIPACK"]
["HSN","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN","J0583 - PR BIVALIRUDIN"]
["HSN","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN","J1815 - PR INSULIN INJECTION"]
["HSN","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN","J2001 - PR LIDOCAINE INJECTION"]
["HSN","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN","J8540 - PR ORAL DEXAMETHASONE"]
["HSN","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN BAD DEBT","A9576 - INJ PROHANCE MULTIPACK"]
["HSN BAD DEBT","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN BAD DEBT","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN BAD DEBT","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN BAD DEBT","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN BAD DEBT","J0583 - PR BIVALIRUDIN"]
["HSN BAD DEBT","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN BAD DEBT","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN BAD DEBT","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN BAD DEBT","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN BAD DEBT","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN BAD DEBT","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN BAD DEBT","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN BAD DEBT","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN BAD DEBT","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN BAD DEBT","J1815 - PR INSULIN INJECTION"]
["HSN BAD DEBT","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN BAD DEBT","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN BAD DEBT","J2001 - PR LIDOCAINE INJECTION"]
["HSN BAD DEBT","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN BAD DEBT","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN BAD DEBT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN BAD DEBT","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN BAD DEBT","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN BAD DEBT","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN BAD DEBT","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN BAD DEBT","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN BAD DEBT","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN BAD DEBT","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN BAD DEBT","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN BAD DEBT","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN BAD DEBT","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN BAD DEBT","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN BAD DEBT","J8540 - PR ORAL DEXAMETHASONE"]
["HSN BAD DEBT","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN BAD DEBT","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN BAD DEBT","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN BAD DEBT","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN BAD DEBT","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN BAD DEBT","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN CONFIDENTIAL","A9576 - INJ PROHANCE MULTIPACK"]
["HSN CONFIDENTIAL","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN CONFIDENTIAL","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN CONFIDENTIAL","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN CONFIDENTIAL","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN CONFIDENTIAL","J0583 - PR BIVALIRUDIN"]
["HSN CONFIDENTIAL","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN CONFIDENTIAL","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN CONFIDENTIAL","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN CONFIDENTIAL","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN CONFIDENTIAL","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN CONFIDENTIAL","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN CONFIDENTIAL","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN CONFIDENTIAL","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN CONFIDENTIAL","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN CONFIDENTIAL","J1815 - PR INSULIN INJECTION"]
["HSN CONFIDENTIAL","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN CONFIDENTIAL","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN CONFIDENTIAL","J2001 - PR LIDOCAINE INJECTION"]
["HSN CONFIDENTIAL","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN CONFIDENTIAL","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN CONFIDENTIAL","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN CONFIDENTIAL","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN CONFIDENTIAL","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN CONFIDENTIAL","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN CONFIDENTIAL","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN CONFIDENTIAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN CONFIDENTIAL","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN CONFIDENTIAL","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN CONFIDENTIAL","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN CONFIDENTIAL","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN CONFIDENTIAL","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN CONFIDENTIAL","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN CONFIDENTIAL","J8540 - PR ORAL DEXAMETHASONE"]
["HSN CONFIDENTIAL","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN CONFIDENTIAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN CONFIDENTIAL","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN CONFIDENTIAL","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN CONFIDENTIAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN CONFIDENTIAL","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN DENTAL","A9576 - INJ PROHANCE MULTIPACK"]
["HSN DENTAL","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN DENTAL","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN DENTAL","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN DENTAL","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN DENTAL","J0583 - PR BIVALIRUDIN"]
["HSN DENTAL","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN DENTAL","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN DENTAL","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN DENTAL","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN DENTAL","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN DENTAL","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN DENTAL","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN DENTAL","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN DENTAL","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN DENTAL","J1815 - PR INSULIN INJECTION"]
["HSN DENTAL","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN DENTAL","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN DENTAL","J2001 - PR LIDOCAINE INJECTION"]
["HSN DENTAL","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN DENTAL","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN DENTAL","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN DENTAL","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN DENTAL","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN DENTAL","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN DENTAL","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN DENTAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN DENTAL","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN DENTAL","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN DENTAL","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN DENTAL","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN DENTAL","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN DENTAL","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN DENTAL","J8540 - PR ORAL DEXAMETHASONE"]
["HSN DENTAL","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN DENTAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN DENTAL","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN DENTAL","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN DENTAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN DENTAL","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN PARTIAL","A9576 - INJ PROHANCE MULTIPACK"]
["HSN PARTIAL","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN PARTIAL","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN PARTIAL","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN PARTIAL","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN PARTIAL","J0583 - PR BIVALIRUDIN"]
["HSN PARTIAL","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN PARTIAL","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN PARTIAL","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN PARTIAL","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN PARTIAL","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN PARTIAL","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN PARTIAL","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN PARTIAL","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN PARTIAL","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN PARTIAL","J1815 - PR INSULIN INJECTION"]
["HSN PARTIAL","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN PARTIAL","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN PARTIAL","J2001 - PR LIDOCAINE INJECTION"]
["HSN PARTIAL","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN PARTIAL","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN PARTIAL","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN PARTIAL","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN PARTIAL","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN PARTIAL","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN PARTIAL","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN PARTIAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN PARTIAL","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN PARTIAL","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN PARTIAL","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN PARTIAL","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN PARTIAL","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN PARTIAL","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN PARTIAL","J8540 - PR ORAL DEXAMETHASONE"]
["HSN PARTIAL","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN PARTIAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN PARTIAL","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN PARTIAL","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN PARTIAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN PARTIAL","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HUMANA MEDICARE","A9576 - INJ PROHANCE MULTIPACK"]
["HUMANA MEDICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HUMANA MEDICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["HUMANA MEDICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["HUMANA MEDICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HUMANA MEDICARE","J0583 - PR BIVALIRUDIN"]
["HUMANA MEDICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HUMANA MEDICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HUMANA MEDICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HUMANA MEDICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HUMANA MEDICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["HUMANA MEDICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HUMANA MEDICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HUMANA MEDICARE","J1815 - PR INSULIN INJECTION"]
["HUMANA MEDICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HUMANA MEDICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["HUMANA MEDICARE","J2001 - PR LIDOCAINE INJECTION"]
["HUMANA MEDICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["HUMANA MEDICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HUMANA MEDICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HUMANA MEDICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["HUMANA MEDICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HUMANA MEDICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["HUMANA MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HUMANA MEDICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HUMANA MEDICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HUMANA MEDICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HUMANA MEDICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["HUMANA MEDICARE","J8540 - PR ORAL DEXAMETHASONE"]
["HUMANA MEDICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["HUMANA MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HUMANA MEDICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["HUMANA MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HUMANA MEDICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9576 - INJ PROHANCE MULTIPACK"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","C9257 - PR BEVACIZUMAB INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0131 - PR ACETAMINOPHEN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0583 - PR BIVALIRUDIN"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1170 - PR HYDROMORPHONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1561 - PR GAMUNEX-C/GAMMAKED"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1815 - PR INSULIN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1953 - PR LEVETIRACETAM INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2001 - PR LIDOCAINE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2270 - PR MORPHINE SULFATE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2704 - PR INJ, PROPFOL, 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J3010 - PR FENTANYL CITRATE INJECITON"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J7131 - PR HYPERTONIC SALINE SOL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J8540 - PR ORAL DEXAMETHASONE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J9041 - PR INJ., VELCADE 0.1 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","Q0249 - TOCILIZUMAB FOR COVID-19"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","Q5114 - PR INJ OGIVRI 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","A9576 - INJ PROHANCE MULTIPACK"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","C9257 - PR BEVACIZUMAB INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0131 - PR ACETAMINOPHEN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0583 - PR BIVALIRUDIN"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1170 - PR HYDROMORPHONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1561 - PR GAMUNEX-C/GAMMAKED"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1815 - PR INSULIN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1953 - PR LEVETIRACETAM INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2001 - PR LIDOCAINE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2270 - PR MORPHINE SULFATE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2704 - PR INJ, PROPFOL, 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J3010 - PR FENTANYL CITRATE INJECITON"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J7131 - PR HYPERTONIC SALINE SOL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J8540 - PR ORAL DEXAMETHASONE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J9041 - PR INJ., VELCADE 0.1 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","Q0249 - TOCILIZUMAB FOR COVID-19"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","Q5114 - PR INJ OGIVRI 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["MEDICARE","A9576 - INJ PROHANCE MULTIPACK"]
["MEDICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["MEDICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["MEDICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["MEDICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["MEDICARE","J0583 - PR BIVALIRUDIN"]
["MEDICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["MEDICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["MEDICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["MEDICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["MEDICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["MEDICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["MEDICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["MEDICARE","J1815 - PR INSULIN INJECTION"]
["MEDICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["MEDICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["MEDICARE","J2001 - PR LIDOCAINE INJECTION"]
["MEDICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["MEDICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["MEDICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["MEDICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["MEDICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["MEDICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["MEDICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["MEDICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["MEDICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["MEDICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["MEDICARE","J8540 - PR ORAL DEXAMETHASONE"]
["MEDICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["MEDICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MEDICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["NEIGHBORHOOD PACE","A9576 - INJ PROHANCE MULTIPACK"]
["NEIGHBORHOOD PACE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["NEIGHBORHOOD PACE","C9257 - PR BEVACIZUMAB INJECTION"]
["NEIGHBORHOOD PACE","J0131 - PR ACETAMINOPHEN INJECTION"]
["NEIGHBORHOOD PACE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["NEIGHBORHOOD PACE","J0583 - PR BIVALIRUDIN"]
["NEIGHBORHOOD PACE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["NEIGHBORHOOD PACE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["NEIGHBORHOOD PACE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["NEIGHBORHOOD PACE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["NEIGHBORHOOD PACE","J1170 - PR HYDROMORPHONE INJECTION"]
["NEIGHBORHOOD PACE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["NEIGHBORHOOD PACE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["NEIGHBORHOOD PACE","J1815 - PR INSULIN INJECTION"]
["NEIGHBORHOOD PACE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["NEIGHBORHOOD PACE","J1953 - PR LEVETIRACETAM INJECTION"]
["NEIGHBORHOOD PACE","J2001 - PR LIDOCAINE INJECTION"]
["NEIGHBORHOOD PACE","J2270 - PR MORPHINE SULFATE INJECTION"]
["NEIGHBORHOOD PACE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["NEIGHBORHOOD PACE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["NEIGHBORHOOD PACE","J2704 - PR INJ, PROPFOL, 10 MG"]
["NEIGHBORHOOD PACE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["NEIGHBORHOOD PACE","J3010 - PR FENTANYL CITRATE INJECITON"]
["NEIGHBORHOOD PACE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["NEIGHBORHOOD PACE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["NEIGHBORHOOD PACE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["NEIGHBORHOOD PACE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["NEIGHBORHOOD PACE","J7131 - PR HYPERTONIC SALINE SOL"]
["NEIGHBORHOOD PACE","J8540 - PR ORAL DEXAMETHASONE"]
["NEIGHBORHOOD PACE","J9041 - PR INJ., VELCADE 0.1 MG"]
["NEIGHBORHOOD PACE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["NEIGHBORHOOD PACE","Q5114 - PR INJ OGIVRI 10 MG"]
["NEIGHBORHOOD PACE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["NEIGHBORHOOD PACE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["OXFORD HEALTH","A9576 - INJ PROHANCE MULTIPACK"]
["OXFORD HEALTH","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["OXFORD HEALTH","C9257 - PR BEVACIZUMAB INJECTION"]
["OXFORD HEALTH","J0131 - PR ACETAMINOPHEN INJECTION"]
["OXFORD HEALTH","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["OXFORD HEALTH","J0583 - PR BIVALIRUDIN"]
["OXFORD HEALTH","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["OXFORD HEALTH","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["OXFORD HEALTH","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["OXFORD HEALTH","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["OXFORD HEALTH","J1170 - PR HYDROMORPHONE INJECTION"]
["OXFORD HEALTH","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["OXFORD HEALTH","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["OXFORD HEALTH","J1815 - PR INSULIN INJECTION"]
["OXFORD HEALTH","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["OXFORD HEALTH","J1953 - PR LEVETIRACETAM INJECTION"]
["OXFORD HEALTH","J2001 - PR LIDOCAINE INJECTION"]
["OXFORD HEALTH","J2270 - PR MORPHINE SULFATE INJECTION"]
["OXFORD HEALTH","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["OXFORD HEALTH","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["OXFORD HEALTH","J2704 - PR INJ, PROPFOL, 10 MG"]
["OXFORD HEALTH","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["OXFORD HEALTH","J3010 - PR FENTANYL CITRATE INJECITON"]
["OXFORD HEALTH","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["OXFORD HEALTH","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["OXFORD HEALTH","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["OXFORD HEALTH","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["OXFORD HEALTH","J7131 - PR HYPERTONIC SALINE SOL"]
["OXFORD HEALTH","J8540 - PR ORAL DEXAMETHASONE"]
["OXFORD HEALTH","J9041 - PR INJ., VELCADE 0.1 MG"]
["OXFORD HEALTH","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["OXFORD HEALTH","Q0249 - TOCILIZUMAB FOR COVID-19"]
["OXFORD HEALTH","Q5114 - PR INJ OGIVRI 10 MG"]
["OXFORD HEALTH","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["OXFORD HEALTH","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["SENIOR WHOLE HEALTH","A9576 - INJ PROHANCE MULTIPACK"]
["SENIOR WHOLE HEALTH","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["SENIOR WHOLE HEALTH","C9257 - PR BEVACIZUMAB INJECTION"]
["SENIOR WHOLE HEALTH","J0131 - PR ACETAMINOPHEN INJECTION"]
["SENIOR WHOLE HEALTH","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["SENIOR WHOLE HEALTH","J0583 - PR BIVALIRUDIN"]
["SENIOR WHOLE HEALTH","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["SENIOR WHOLE HEALTH","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["SENIOR WHOLE HEALTH","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["SENIOR WHOLE HEALTH","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["SENIOR WHOLE HEALTH","J1170 - PR HYDROMORPHONE INJECTION"]
["SENIOR WHOLE HEALTH","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["SENIOR WHOLE HEALTH","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["SENIOR WHOLE HEALTH","J1815 - PR INSULIN INJECTION"]
["SENIOR WHOLE HEALTH","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["SENIOR WHOLE HEALTH","J1953 - PR LEVETIRACETAM INJECTION"]
["SENIOR WHOLE HEALTH","J2001 - PR LIDOCAINE INJECTION"]
["SENIOR WHOLE HEALTH","J2270 - PR MORPHINE SULFATE INJECTION"]
["SENIOR WHOLE HEALTH","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["SENIOR WHOLE HEALTH","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["SENIOR WHOLE HEALTH","J2704 - PR INJ, PROPFOL, 10 MG"]
["SENIOR WHOLE HEALTH","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["SENIOR WHOLE HEALTH","J3010 - PR FENTANYL CITRATE INJECITON"]
["SENIOR WHOLE HEALTH","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["SENIOR WHOLE HEALTH","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["SENIOR WHOLE HEALTH","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["SENIOR WHOLE HEALTH","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["SENIOR WHOLE HEALTH","J7131 - PR HYPERTONIC SALINE SOL"]
["SENIOR WHOLE HEALTH","J8540 - PR ORAL DEXAMETHASONE"]
["SENIOR WHOLE HEALTH","J9041 - PR INJ., VELCADE 0.1 MG"]
["SENIOR WHOLE HEALTH","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["SENIOR WHOLE HEALTH","Q5114 - PR INJ OGIVRI 10 MG"]
["SENIOR WHOLE HEALTH","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TRICARE EAST","A9576 - INJ PROHANCE MULTIPACK"]
["TRICARE EAST","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TRICARE EAST","C9257 - PR BEVACIZUMAB INJECTION"]
["TRICARE EAST","J0131 - PR ACETAMINOPHEN INJECTION"]
["TRICARE EAST","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TRICARE EAST","J0583 - PR BIVALIRUDIN"]
["TRICARE EAST","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TRICARE EAST","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TRICARE EAST","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TRICARE EAST","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TRICARE EAST","J1170 - PR HYDROMORPHONE INJECTION"]
["TRICARE EAST","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TRICARE EAST","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TRICARE EAST","J1815 - PR INSULIN INJECTION"]
["TRICARE EAST","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TRICARE EAST","J1953 - PR LEVETIRACETAM INJECTION"]
["TRICARE EAST","J2001 - PR LIDOCAINE INJECTION"]
["TRICARE EAST","J2270 - PR MORPHINE SULFATE INJECTION"]
["TRICARE EAST","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TRICARE EAST","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TRICARE EAST","J2704 - PR INJ, PROPFOL, 10 MG"]
["TRICARE EAST","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TRICARE EAST","J3010 - PR FENTANYL CITRATE INJECITON"]
["TRICARE EAST","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TRICARE EAST","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TRICARE EAST","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TRICARE EAST","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TRICARE EAST","J7131 - PR HYPERTONIC SALINE SOL"]
["TRICARE EAST","J8540 - PR ORAL DEXAMETHASONE"]
["TRICARE EAST","J9041 - PR INJ., VELCADE 0.1 MG"]
["TRICARE EAST","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TRICARE EAST","Q5114 - PR INJ OGIVRI 10 MG"]
["TRICARE EAST","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TRICARE EAST","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TRICARE FOR LIFE","A9576 - INJ PROHANCE MULTIPACK"]
["TRICARE FOR LIFE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TRICARE FOR LIFE","C9257 - PR BEVACIZUMAB INJECTION"]
["TRICARE FOR LIFE","J0131 - PR ACETAMINOPHEN INJECTION"]
["TRICARE FOR LIFE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TRICARE FOR LIFE","J0583 - PR BIVALIRUDIN"]
["TRICARE FOR LIFE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TRICARE FOR LIFE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TRICARE FOR LIFE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TRICARE FOR LIFE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TRICARE FOR LIFE","J1170 - PR HYDROMORPHONE INJECTION"]
["TRICARE FOR LIFE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TRICARE FOR LIFE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TRICARE FOR LIFE","J1815 - PR INSULIN INJECTION"]
["TRICARE FOR LIFE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TRICARE FOR LIFE","J1953 - PR LEVETIRACETAM INJECTION"]
["TRICARE FOR LIFE","J2001 - PR LIDOCAINE INJECTION"]
["TRICARE FOR LIFE","J2270 - PR MORPHINE SULFATE INJECTION"]
["TRICARE FOR LIFE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TRICARE FOR LIFE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TRICARE FOR LIFE","J2704 - PR INJ, PROPFOL, 10 MG"]
["TRICARE FOR LIFE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TRICARE FOR LIFE","J3010 - PR FENTANYL CITRATE INJECITON"]
["TRICARE FOR LIFE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TRICARE FOR LIFE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TRICARE FOR LIFE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TRICARE FOR LIFE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TRICARE FOR LIFE","J7131 - PR HYPERTONIC SALINE SOL"]
["TRICARE FOR LIFE","J8540 - PR ORAL DEXAMETHASONE"]
["TRICARE FOR LIFE","J9041 - PR INJ., VELCADE 0.1 MG"]
["TRICARE FOR LIFE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TRICARE FOR LIFE","Q5114 - PR INJ OGIVRI 10 MG"]
["TRICARE FOR LIFE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TRICARE FOR LIFE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TUFTS","A9576 - INJ PROHANCE MULTIPACK"]
["TUFTS","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TUFTS","C9257 - PR BEVACIZUMAB INJECTION"]
["TUFTS","J0131 - PR ACETAMINOPHEN INJECTION"]
["TUFTS","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TUFTS","J0583 - PR BIVALIRUDIN"]
["TUFTS","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TUFTS","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TUFTS","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TUFTS","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["TUFTS","J1170 - PR HYDROMORPHONE INJECTION"]
["TUFTS","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TUFTS","J1561 - PR GAMUNEX-C/GAMMAKED"]
["TUFTS","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TUFTS","J1815 - PR INSULIN INJECTION"]
["TUFTS","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TUFTS","J1953 - PR LEVETIRACETAM INJECTION"]
["TUFTS","J2001 - PR LIDOCAINE INJECTION"]
["TUFTS","J2270 - PR MORPHINE SULFATE INJECTION"]
["TUFTS","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TUFTS","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TUFTS","J2704 - PR INJ, PROPFOL, 10 MG"]
["TUFTS","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["TUFTS","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TUFTS","J3010 - PR FENTANYL CITRATE INJECITON"]
["TUFTS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TUFTS","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TUFTS","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TUFTS","J7131 - PR HYPERTONIC SALINE SOL"]
["TUFTS","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["TUFTS","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["TUFTS","J8540 - PR ORAL DEXAMETHASONE"]
["TUFTS","J9041 - PR INJ., VELCADE 0.1 MG"]
["TUFTS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS","Q0249 - TOCILIZUMAB FOR COVID-19"]
["TUFTS","Q5114 - PR INJ OGIVRI 10 MG"]
["TUFTS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TUFTS CONNCARE/QHP","A9576 - INJ PROHANCE MULTIPACK"]
["TUFTS CONNCARE/QHP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TUFTS CONNCARE/QHP","C9257 - PR BEVACIZUMAB INJECTION"]
["TUFTS CONNCARE/QHP","J0131 - PR ACETAMINOPHEN INJECTION"]
["TUFTS CONNCARE/QHP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TUFTS CONNCARE/QHP","J0583 - PR BIVALIRUDIN"]
["TUFTS CONNCARE/QHP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TUFTS CONNCARE/QHP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TUFTS CONNCARE/QHP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS CONNCARE/QHP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TUFTS CONNCARE/QHP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["TUFTS CONNCARE/QHP","J1170 - PR HYDROMORPHONE INJECTION"]
["TUFTS CONNCARE/QHP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TUFTS CONNCARE/QHP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["TUFTS CONNCARE/QHP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TUFTS CONNCARE/QHP","J1815 - PR INSULIN INJECTION"]
["TUFTS CONNCARE/QHP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TUFTS CONNCARE/QHP","J1953 - PR LEVETIRACETAM INJECTION"]
["TUFTS CONNCARE/QHP","J2001 - PR LIDOCAINE INJECTION"]
["TUFTS CONNCARE/QHP","J2270 - PR MORPHINE SULFATE INJECTION"]
["TUFTS CONNCARE/QHP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TUFTS CONNCARE/QHP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TUFTS CONNCARE/QHP","J2704 - PR INJ, PROPFOL, 10 MG"]
["TUFTS CONNCARE/QHP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["TUFTS CONNCARE/QHP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TUFTS CONNCARE/QHP","J3010 - PR FENTANYL CITRATE INJECITON"]
["TUFTS CONNCARE/QHP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS CONNCARE/QHP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TUFTS CONNCARE/QHP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TUFTS CONNCARE/QHP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TUFTS CONNCARE/QHP","J7131 - PR HYPERTONIC SALINE SOL"]
["TUFTS CONNCARE/QHP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["TUFTS CONNCARE/QHP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["TUFTS CONNCARE/QHP","J8540 - PR ORAL DEXAMETHASONE"]
["TUFTS CONNCARE/QHP","J9041 - PR INJ., VELCADE 0.1 MG"]
["TUFTS CONNCARE/QHP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS CONNCARE/QHP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["TUFTS CONNCARE/QHP","Q5114 - PR INJ OGIVRI 10 MG"]
["TUFTS CONNCARE/QHP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS CONNCARE/QHP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TUFTS MEDICARE","A9576 - INJ PROHANCE MULTIPACK"]
["TUFTS MEDICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TUFTS MEDICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["TUFTS MEDICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["TUFTS MEDICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TUFTS MEDICARE","J0583 - PR BIVALIRUDIN"]
["TUFTS MEDICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TUFTS MEDICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TUFTS MEDICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS MEDICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TUFTS MEDICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["TUFTS MEDICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TUFTS MEDICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TUFTS MEDICARE","J1815 - PR INSULIN INJECTION"]
["TUFTS MEDICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TUFTS MEDICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["TUFTS MEDICARE","J2001 - PR LIDOCAINE INJECTION"]
["TUFTS MEDICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["TUFTS MEDICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TUFTS MEDICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TUFTS MEDICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["TUFTS MEDICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TUFTS MEDICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["TUFTS MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS MEDICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TUFTS MEDICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TUFTS MEDICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TUFTS MEDICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["TUFTS MEDICARE","J8540 - PR ORAL DEXAMETHASONE"]
["TUFTS MEDICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["TUFTS MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS MEDICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["TUFTS MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS MEDICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TUFTS MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["TUFTS MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TUFTS MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["TUFTS MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["TUFTS MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TUFTS MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["TUFTS MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TUFTS MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TUFTS MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TUFTS MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["TUFTS MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TUFTS MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TUFTS MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["TUFTS MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TUFTS MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["TUFTS MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["TUFTS MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["TUFTS MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TUFTS MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TUFTS MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["TUFTS MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TUFTS MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["TUFTS MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TUFTS MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TUFTS MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TUFTS MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["TUFTS MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["TUFTS MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["TUFTS MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["TUFTS MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UBH HPHC","A9576 - INJ PROHANCE MULTIPACK"]
["UBH HPHC","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UBH HPHC","C9257 - PR BEVACIZUMAB INJECTION"]
["UBH HPHC","J0131 - PR ACETAMINOPHEN INJECTION"]
["UBH HPHC","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UBH HPHC","J0583 - PR BIVALIRUDIN"]
["UBH HPHC","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UBH HPHC","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UBH HPHC","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UBH HPHC","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UBH HPHC","J1170 - PR HYDROMORPHONE INJECTION"]
["UBH HPHC","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UBH HPHC","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UBH HPHC","J1815 - PR INSULIN INJECTION"]
["UBH HPHC","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UBH HPHC","J1953 - PR LEVETIRACETAM INJECTION"]
["UBH HPHC","J2001 - PR LIDOCAINE INJECTION"]
["UBH HPHC","J2270 - PR MORPHINE SULFATE INJECTION"]
["UBH HPHC","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UBH HPHC","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UBH HPHC","J2704 - PR INJ, PROPFOL, 10 MG"]
["UBH HPHC","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UBH HPHC","J3010 - PR FENTANYL CITRATE INJECITON"]
["UBH HPHC","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UBH HPHC","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UBH HPHC","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UBH HPHC","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UBH HPHC","J7131 - PR HYPERTONIC SALINE SOL"]
["UBH HPHC","J8540 - PR ORAL DEXAMETHASONE"]
["UBH HPHC","J9041 - PR INJ., VELCADE 0.1 MG"]
["UBH HPHC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UBH HPHC","Q5114 - PR INJ OGIVRI 10 MG"]
["UBH HPHC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UBH HPHC","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UNICARE","A9576 - INJ PROHANCE MULTIPACK"]
["UNICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UNICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["UNICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["UNICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UNICARE","J0583 - PR BIVALIRUDIN"]
["UNICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UNICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UNICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UNICARE","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["UNICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["UNICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UNICARE","J1561 - PR GAMUNEX-C/GAMMAKED"]
["UNICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UNICARE","J1815 - PR INSULIN INJECTION"]
["UNICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UNICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["UNICARE","J2001 - PR LIDOCAINE INJECTION"]
["UNICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["UNICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UNICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UNICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["UNICARE","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["UNICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UNICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["UNICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UNICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UNICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UNICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["UNICARE","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["UNICARE","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["UNICARE","J8540 - PR ORAL DEXAMETHASONE"]
["UNICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["UNICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNICARE","Q0249 - TOCILIZUMAB FOR COVID-19"]
["UNICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["UNICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UNITED","A9576 - INJ PROHANCE MULTIPACK"]
["UNITED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UNITED","C9257 - PR BEVACIZUMAB INJECTION"]
["UNITED","J0131 - PR ACETAMINOPHEN INJECTION"]
["UNITED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UNITED","J0583 - PR BIVALIRUDIN"]
["UNITED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UNITED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UNITED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNITED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UNITED","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["UNITED","J1170 - PR HYDROMORPHONE INJECTION"]
["UNITED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UNITED","J1561 - PR GAMUNEX-C/GAMMAKED"]
["UNITED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UNITED","J1815 - PR INSULIN INJECTION"]
["UNITED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UNITED","J1953 - PR LEVETIRACETAM INJECTION"]
["UNITED","J2001 - PR LIDOCAINE INJECTION"]
["UNITED","J2270 - PR MORPHINE SULFATE INJECTION"]
["UNITED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UNITED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UNITED","J2704 - PR INJ, PROPFOL, 10 MG"]
["UNITED","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["UNITED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UNITED","J3010 - PR FENTANYL CITRATE INJECITON"]
["UNITED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UNITED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UNITED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UNITED","J7131 - PR HYPERTONIC SALINE SOL"]
["UNITED","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["UNITED","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["UNITED","J8540 - PR ORAL DEXAMETHASONE"]
["UNITED","J9041 - PR INJ., VELCADE 0.1 MG"]
["UNITED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNITED","Q0249 - TOCILIZUMAB FOR COVID-19"]
["UNITED","Q5114 - PR INJ OGIVRI 10 MG"]
["UNITED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UNITED COMMUNITY PLAN","A9576 - INJ PROHANCE MULTIPACK"]
["UNITED COMMUNITY PLAN","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UNITED COMMUNITY PLAN","C9257 - PR BEVACIZUMAB INJECTION"]
["UNITED COMMUNITY PLAN","J0131 - PR ACETAMINOPHEN INJECTION"]
["UNITED COMMUNITY PLAN","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UNITED COMMUNITY PLAN","J0583 - PR BIVALIRUDIN"]
["UNITED COMMUNITY PLAN","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UNITED COMMUNITY PLAN","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UNITED COMMUNITY PLAN","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNITED COMMUNITY PLAN","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UNITED COMMUNITY PLAN","J1170 - PR HYDROMORPHONE INJECTION"]
["UNITED COMMUNITY PLAN","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UNITED COMMUNITY PLAN","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UNITED COMMUNITY PLAN","J1815 - PR INSULIN INJECTION"]
["UNITED COMMUNITY PLAN","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UNITED COMMUNITY PLAN","J1953 - PR LEVETIRACETAM INJECTION"]
["UNITED COMMUNITY PLAN","J2001 - PR LIDOCAINE INJECTION"]
["UNITED COMMUNITY PLAN","J2270 - PR MORPHINE SULFATE INJECTION"]
["UNITED COMMUNITY PLAN","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UNITED COMMUNITY PLAN","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UNITED COMMUNITY PLAN","J2704 - PR INJ, PROPFOL, 10 MG"]
["UNITED COMMUNITY PLAN","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UNITED COMMUNITY PLAN","J3010 - PR FENTANYL CITRATE INJECITON"]
["UNITED COMMUNITY PLAN","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED COMMUNITY PLAN","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UNITED COMMUNITY PLAN","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UNITED COMMUNITY PLAN","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UNITED COMMUNITY PLAN","J7131 - PR HYPERTONIC SALINE SOL"]
["UNITED COMMUNITY PLAN","J8540 - PR ORAL DEXAMETHASONE"]
["UNITED COMMUNITY PLAN","J9041 - PR INJ., VELCADE 0.1 MG"]
["UNITED COMMUNITY PLAN","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNITED COMMUNITY PLAN","Q5114 - PR INJ OGIVRI 10 MG"]
["UNITED COMMUNITY PLAN","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED COMMUNITY PLAN","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UNITED MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["UNITED MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UNITED MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["UNITED MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["UNITED MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UNITED MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["UNITED MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UNITED MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UNITED MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNITED MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UNITED MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["UNITED MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UNITED MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UNITED MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["UNITED MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UNITED MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["UNITED MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["UNITED MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["UNITED MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UNITED MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UNITED MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["UNITED MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UNITED MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["UNITED MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UNITED MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UNITED MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UNITED MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["UNITED MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["UNITED MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["UNITED MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNITED MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["UNITED MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UPHAMS CORNER ESP","A9576 - INJ PROHANCE MULTIPACK"]
["UPHAMS CORNER ESP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UPHAMS CORNER ESP","C9257 - PR BEVACIZUMAB INJECTION"]
["UPHAMS CORNER ESP","J0131 - PR ACETAMINOPHEN INJECTION"]
["UPHAMS CORNER ESP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UPHAMS CORNER ESP","J0583 - PR BIVALIRUDIN"]
["UPHAMS CORNER ESP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UPHAMS CORNER ESP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UPHAMS CORNER ESP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UPHAMS CORNER ESP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UPHAMS CORNER ESP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["UPHAMS CORNER ESP","J1170 - PR HYDROMORPHONE INJECTION"]
["UPHAMS CORNER ESP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UPHAMS CORNER ESP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["UPHAMS CORNER ESP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UPHAMS CORNER ESP","J1815 - PR INSULIN INJECTION"]
["UPHAMS CORNER ESP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UPHAMS CORNER ESP","J1953 - PR LEVETIRACETAM INJECTION"]
["UPHAMS CORNER ESP","J2001 - PR LIDOCAINE INJECTION"]
["UPHAMS CORNER ESP","J2270 - PR MORPHINE SULFATE INJECTION"]
["UPHAMS CORNER ESP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UPHAMS CORNER ESP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UPHAMS CORNER ESP","J2704 - PR INJ, PROPFOL, 10 MG"]
["UPHAMS CORNER ESP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["UPHAMS CORNER ESP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UPHAMS CORNER ESP","J3010 - PR FENTANYL CITRATE INJECITON"]
["UPHAMS CORNER ESP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UPHAMS CORNER ESP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UPHAMS CORNER ESP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UPHAMS CORNER ESP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UPHAMS CORNER ESP","J7131 - PR HYPERTONIC SALINE SOL"]
["UPHAMS CORNER ESP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["UPHAMS CORNER ESP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["UPHAMS CORNER ESP","J8540 - PR ORAL DEXAMETHASONE"]
["UPHAMS CORNER ESP","J9041 - PR INJ., VELCADE 0.1 MG"]
["UPHAMS CORNER ESP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UPHAMS CORNER ESP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["UPHAMS CORNER ESP","Q5114 - PR INJ OGIVRI 10 MG"]
["UPHAMS CORNER ESP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UPHAMS CORNER ESP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["WELLCARE","A9576 - INJ PROHANCE MULTIPACK"]
["WELLCARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["WELLCARE","C9257 - PR BEVACIZUMAB INJECTION"]
["WELLCARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["WELLCARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["WELLCARE","J0583 - PR BIVALIRUDIN"]
["WELLCARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["WELLCARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["WELLCARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["WELLCARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["WELLCARE","J1170 - PR HYDROMORPHONE INJECTION"]
["WELLCARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["WELLCARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["WELLCARE","J1815 - PR INSULIN INJECTION"]
["WELLCARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["WELLCARE","J1953 - PR LEVETIRACETAM INJECTION"]
["WELLCARE","J2001 - PR LIDOCAINE INJECTION"]
["WELLCARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["WELLCARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["WELLCARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["WELLCARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["WELLCARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["WELLCARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["WELLCARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WELLCARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["WELLCARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["WELLCARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["WELLCARE","J7131 - PR HYPERTONIC SALINE SOL"]
["WELLCARE","J8540 - PR ORAL DEXAMETHASONE"]
["WELLCARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["WELLCARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLCARE","Q5114 - PR INJ OGIVRI 10 MG"]
["WELLCARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLCARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9576 - INJ PROHANCE MULTIPACK"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","C9257 - PR BEVACIZUMAB INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0131 - PR ACETAMINOPHEN INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0583 - PR BIVALIRUDIN"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1170 - PR HYDROMORPHONE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1561 - PR GAMUNEX-C/GAMMAKED"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1815 - PR INSULIN INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1953 - PR LEVETIRACETAM INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2001 - PR LIDOCAINE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2270 - PR MORPHINE SULFATE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2704 - PR INJ, PROPFOL, 10 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J3010 - PR FENTANYL CITRATE INJECITON"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J7131 - PR HYPERTONIC SALINE SOL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J8540 - PR ORAL DEXAMETHASONE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J9041 - PR INJ., VELCADE 0.1 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q0249 - TOCILIZUMAB FOR COVID-19"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q5114 - PR INJ OGIVRI 10 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["WELLSENSE MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["WELLSENSE MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["WELLSENSE MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["WELLSENSE MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["WELLSENSE MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["WELLSENSE MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["WELLSENSE MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["WELLSENSE MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["WELLSENSE MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["WELLSENSE MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["WELLSENSE MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["WELLSENSE MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["WELLSENSE MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["WELLSENSE MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["WELLSENSE MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["WELLSENSE MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["WELLSENSE MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["WELLSENSE MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["WELLSENSE MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["WELLSENSE MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["WELLSENSE MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["WELLSENSE MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["WELLSENSE MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["WELLSENSE MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WELLSENSE MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["WELLSENSE MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["WELLSENSE MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["WELLSENSE MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["WELLSENSE MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["WELLSENSE MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["WELLSENSE MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLSENSE MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["WELLSENSE MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLSENSE MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["WORKERS COMP","A9576 - INJ PROHANCE MULTIPACK"]
["WORKERS COMP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["WORKERS COMP","C9257 - PR BEVACIZUMAB INJECTION"]
["WORKERS COMP","J0131 - PR ACETAMINOPHEN INJECTION"]
["WORKERS COMP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["WORKERS COMP","J0583 - PR BIVALIRUDIN"]
["WORKERS COMP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["WORKERS COMP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["WORKERS COMP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["WORKERS COMP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["WORKERS COMP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["WORKERS COMP","J1170 - PR HYDROMORPHONE INJECTION"]
["WORKERS COMP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["WORKERS COMP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["WORKERS COMP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["WORKERS COMP","J1815 - PR INSULIN INJECTION"]
["WORKERS COMP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["WORKERS COMP","J1953 - PR LEVETIRACETAM INJECTION"]
["WORKERS COMP","J2001 - PR LIDOCAINE INJECTION"]
["WORKERS COMP","J2270 - PR MORPHINE SULFATE INJECTION"]
["WORKERS COMP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["WORKERS COMP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["WORKERS COMP","J2704 - PR INJ, PROPFOL, 10 MG"]
["WORKERS COMP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["WORKERS COMP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["WORKERS COMP","J3010 - PR FENTANYL CITRATE INJECITON"]
["WORKERS COMP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WORKERS COMP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["WORKERS COMP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["WORKERS COMP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["WORKERS COMP","J7131 - PR HYPERTONIC SALINE SOL"]
["WORKERS COMP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["WORKERS COMP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["WORKERS COMP","J8540 - PR ORAL DEXAMETHASONE"]
["WORKERS COMP","J9041 - PR INJ., VELCADE 0.1 MG"]
["WORKERS COMP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WORKERS COMP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["WORKERS COMP","Q5114 - PR INJ OGIVRI 10 MG"]
["WORKERS COMP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WORKERS COMP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZAETNA","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZAETNA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZAETNA","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZAETNA","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZAETNA","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZAETNA","J0583 - PR BIVALIRUDIN"]
["ZZZAETNA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZAETNA","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZAETNA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZAETNA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZAETNA","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZAETNA","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZAETNA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZAETNA","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZAETNA","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZAETNA","J1815 - PR INSULIN INJECTION"]
["ZZZAETNA","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZAETNA","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZAETNA","J2001 - PR LIDOCAINE INJECTION"]
["ZZZAETNA","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZAETNA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZAETNA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZAETNA","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZAETNA","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZAETNA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZAETNA","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZAETNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZAETNA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZAETNA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZAETNA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZAETNA","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZAETNA","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZAETNA","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZAETNA","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZAETNA","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZAETNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZAETNA","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZAETNA","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZAETNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZAETNA","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZBU EMPLOYEE WORK COMP","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZBU EMPLOYEE WORK COMP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZBU EMPLOYEE WORK COMP","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZBU EMPLOYEE WORK COMP","J0583 - PR BIVALIRUDIN"]
["ZZZBU EMPLOYEE WORK COMP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZBU EMPLOYEE WORK COMP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZBU EMPLOYEE WORK COMP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZBU EMPLOYEE WORK COMP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZBU EMPLOYEE WORK COMP","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZBU EMPLOYEE WORK COMP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZBU EMPLOYEE WORK COMP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZBU EMPLOYEE WORK COMP","J1815 - PR INSULIN INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZBU EMPLOYEE WORK COMP","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J2001 - PR LIDOCAINE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZBU EMPLOYEE WORK COMP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZBU EMPLOYEE WORK COMP","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZBU EMPLOYEE WORK COMP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZBU EMPLOYEE WORK COMP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZBU EMPLOYEE WORK COMP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZBU EMPLOYEE WORK COMP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZBU EMPLOYEE WORK COMP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZBU EMPLOYEE WORK COMP","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZBU EMPLOYEE WORK COMP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZBU EMPLOYEE WORK COMP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZBU EMPLOYEE WORK COMP","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZBU EMPLOYEE WORK COMP","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZBU EMPLOYEE WORK COMP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZBU EMPLOYEE WORK COMP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZBU EMPLOYEE WORK COMP","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZBU EMPLOYEE WORK COMP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZBU EMPLOYEE WORK COMP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZCCA ONECARE","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZCCA ONECARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZCCA ONECARE","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZCCA ONECARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZCCA ONECARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZCCA ONECARE","J0583 - PR BIVALIRUDIN"]
["ZZZCCA ONECARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZCCA ONECARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZCCA ONECARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZCCA ONECARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZCCA ONECARE","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZCCA ONECARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCCA ONECARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZCCA ONECARE","J1815 - PR INSULIN INJECTION"]
["ZZZCCA ONECARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZCCA ONECARE","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZCCA ONECARE","J2001 - PR LIDOCAINE INJECTION"]
["ZZZCCA ONECARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZCCA ONECARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZCCA ONECARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZCCA ONECARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZCCA ONECARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZCCA ONECARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZCCA ONECARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCCA ONECARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZCCA ONECARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZCCA ONECARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZCCA ONECARE","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZCCA ONECARE","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZCCA ONECARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZCCA ONECARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCCA ONECARE","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZCCA ONECARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZCCA ONECARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZCIGNA","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZCIGNA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZCIGNA","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZCIGNA","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZCIGNA","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZCIGNA","J0583 - PR BIVALIRUDIN"]
["ZZZCIGNA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZCIGNA","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZCIGNA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZCIGNA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZCIGNA","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZCIGNA","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZCIGNA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCIGNA","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZCIGNA","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZCIGNA","J1815 - PR INSULIN INJECTION"]
["ZZZCIGNA","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZCIGNA","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZCIGNA","J2001 - PR LIDOCAINE INJECTION"]
["ZZZCIGNA","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZCIGNA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZCIGNA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZCIGNA","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZCIGNA","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZCIGNA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZCIGNA","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZCIGNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCIGNA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZCIGNA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZCIGNA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZCIGNA","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZCIGNA","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZCIGNA","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZCIGNA","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZCIGNA","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZCIGNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCIGNA","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZCIGNA","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZCIGNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZCIGNA","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZCITY OF BOSTON WORK COMP","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZCITY OF BOSTON WORK COMP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZCITY OF BOSTON WORK COMP","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZCITY OF BOSTON WORK COMP","J0583 - PR BIVALIRUDIN"]
["ZZZCITY OF BOSTON WORK COMP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZCITY OF BOSTON WORK COMP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZCITY OF BOSTON WORK COMP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZCITY OF BOSTON WORK COMP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZCITY OF BOSTON WORK COMP","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCITY OF BOSTON WORK COMP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZCITY OF BOSTON WORK COMP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZCITY OF BOSTON WORK COMP","J1815 - PR INSULIN INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZCITY OF BOSTON WORK COMP","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J2001 - PR LIDOCAINE INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZCITY OF BOSTON WORK COMP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZCITY OF BOSTON WORK COMP","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZCITY OF BOSTON WORK COMP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZCITY OF BOSTON WORK COMP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZCITY OF BOSTON WORK COMP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCITY OF BOSTON WORK COMP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZCITY OF BOSTON WORK COMP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZCITY OF BOSTON WORK COMP","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZCITY OF BOSTON WORK COMP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZCITY OF BOSTON WORK COMP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZCITY OF BOSTON WORK COMP","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZCITY OF BOSTON WORK COMP","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZCITY OF BOSTON WORK COMP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCITY OF BOSTON WORK COMP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZCITY OF BOSTON WORK COMP","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZCITY OF BOSTON WORK COMP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZCITY OF BOSTON WORK COMP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0583 - PR BIVALIRUDIN"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1815 - PR INSULIN INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2001 - PR LIDOCAINE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZHEALTH PLANS INC","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZHEALTH PLANS INC","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZHEALTH PLANS INC","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZHEALTH PLANS INC","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZHEALTH PLANS INC","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZHEALTH PLANS INC","J0583 - PR BIVALIRUDIN"]
["ZZZHEALTH PLANS INC","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZHEALTH PLANS INC","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZHEALTH PLANS INC","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZHEALTH PLANS INC","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZHEALTH PLANS INC","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZHEALTH PLANS INC","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZHEALTH PLANS INC","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZHEALTH PLANS INC","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZHEALTH PLANS INC","J1815 - PR INSULIN INJECTION"]
["ZZZHEALTH PLANS INC","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZHEALTH PLANS INC","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZHEALTH PLANS INC","J2001 - PR LIDOCAINE INJECTION"]
["ZZZHEALTH PLANS INC","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZHEALTH PLANS INC","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZHEALTH PLANS INC","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZHEALTH PLANS INC","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZHEALTH PLANS INC","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZHEALTH PLANS INC","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZHEALTH PLANS INC","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZHEALTH PLANS INC","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZHEALTH PLANS INC","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZHEALTH PLANS INC","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZHEALTH PLANS INC","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZHEALTH PLANS INC","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZHEALTH PLANS INC","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZHEALTH PLANS INC","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZHEALTH PLANS INC","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZHEALTH PLANS INC","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZHEALTH PLANS INC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZHEALTH PLANS INC","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZHEALTH PLANS INC","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZHEALTH PLANS INC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZRAILROAD MEDICARE","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZRAILROAD MEDICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZRAILROAD MEDICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZRAILROAD MEDICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZRAILROAD MEDICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZRAILROAD MEDICARE","J0583 - PR BIVALIRUDIN"]
["ZZZRAILROAD MEDICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZRAILROAD MEDICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZRAILROAD MEDICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZRAILROAD MEDICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZRAILROAD MEDICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZRAILROAD MEDICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZRAILROAD MEDICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZRAILROAD MEDICARE","J1815 - PR INSULIN INJECTION"]
["ZZZRAILROAD MEDICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZRAILROAD MEDICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZRAILROAD MEDICARE","J2001 - PR LIDOCAINE INJECTION"]
["ZZZRAILROAD MEDICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZRAILROAD MEDICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZRAILROAD MEDICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZRAILROAD MEDICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZRAILROAD MEDICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZRAILROAD MEDICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZRAILROAD MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZRAILROAD MEDICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZRAILROAD MEDICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZRAILROAD MEDICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZRAILROAD MEDICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZRAILROAD MEDICARE","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZRAILROAD MEDICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZRAILROAD MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZRAILROAD MEDICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZRAILROAD MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZRAILROAD MEDICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZUNITED","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZUNITED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZUNITED","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZUNITED","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZUNITED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZUNITED","J0583 - PR BIVALIRUDIN"]
["ZZZUNITED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZUNITED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZUNITED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZUNITED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZUNITED","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZUNITED","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZUNITED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZUNITED","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZUNITED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZUNITED","J1815 - PR INSULIN INJECTION"]
["ZZZUNITED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZUNITED","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZUNITED","J2001 - PR LIDOCAINE INJECTION"]
["ZZZUNITED","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZUNITED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZUNITED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZUNITED","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZUNITED","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZUNITED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZUNITED","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZUNITED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZUNITED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZUNITED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZUNITED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZUNITED","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZUNITED","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZUNITED","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZUNITED","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZUNITED","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZUNITED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZUNITED","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZUNITED","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZUNITED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZUNITED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]

{"sheet":"PayerBillCodeCount (HCPCS)","index":28,"n_rows":1961,"n_cols":8,"rows_kept":1961,"cut":false,"hidden":true,"merged":[[0,0,0,1],[0,6,0,7]]}
["Unique Payer + HCPCS combination",null,null,null,null,null,"HCPCS Count per Payer"]
["Payer","Bill Code & Description",null,null,null,null,"Payer","Count of Bill Code & Description"]
["AARP UHC MEDICARE COMPLETE","A9576 - INJ PROHANCE MULTIPACK",null,null,null,null,"UNICARE",40]
["AARP UHC MEDICARE COMPLETE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",null,null,null,null,"ZZZCITY OF BOSTON WORK COMP",40]
["AARP UHC MEDICARE COMPLETE","C9257 - PR BEVACIZUMAB INJECTION",null,null,null,null,"WORKERS COMP",40]
["AARP UHC MEDICARE COMPLETE","J0131 - PR ACETAMINOPHEN INJECTION",null,null,null,null,"AETNA",40]
["AARP UHC MEDICARE COMPLETE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",null,null,null,null,"TUFTS",40]
["AARP UHC MEDICARE COMPLETE","J0583 - PR BIVALIRUDIN",null,null,null,null,"BCBS",40]
["AARP UHC MEDICARE COMPLETE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",null,null,null,null,"UPHAMS CORNER ESP",40]
["AARP UHC MEDICARE COMPLETE","J0690 - PR CEFAZOLIN SODIUM INJECTION",null,null,null,null,"BCBS OUT OF STATE",40]
["AARP UHC MEDICARE COMPLETE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",null,null,null,null,"ZZZBU EMPLOYEE WORK COMP",40]
["AARP UHC MEDICARE COMPLETE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",null,null,null,null,"CIGNA",40]
["AARP UHC MEDICARE COMPLETE","J1170 - PR HYDROMORPHONE INJECTION",null,null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN PRIME",40]
["AARP UHC MEDICARE COMPLETE","J1250 - PR INJ DOBUTAMINE HCL/250 MG",null,null,null,null,"FALLON",40]
["AARP UHC MEDICARE COMPLETE","J1580 - PR GARAMYCIN GENTAMICIN INJ",null,null,null,null,"TUFTS CONNCARE/QHP",40]
["AARP UHC MEDICARE COMPLETE","J1815 - PR INSULIN INJECTION",null,null,null,null,"HSN",40]
["AARP UHC MEDICARE COMPLETE","J1817 - PR INSULIN FOR INSULIN PUMP USE",null,null,null,null,"UNITED",40]
["AARP UHC MEDICARE COMPLETE","J1953 - PR LEVETIRACETAM INJECTION",null,null,null,null,"HSN BAD DEBT",40]
["AARP UHC MEDICARE COMPLETE","J2001 - PR LIDOCAINE INJECTION",null,null,null,null,"WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE",40]
["AARP UHC MEDICARE COMPLETE","J2270 - PR MORPHINE SULFATE INJECTION",null,null,null,null,"HSN CONFIDENTIAL",40]
["AARP UHC MEDICARE COMPLETE","J2310 - PR INJ NALOXONE HYDROCHLORIDE",null,null,null,null,"ZZZAETNA",40]
["AARP UHC MEDICARE COMPLETE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT",null,null,null,null,"HSN DENTAL",40]
["AARP UHC MEDICARE COMPLETE","J2704 - PR INJ, PROPFOL, 10 MG",null,null,null,null,"ZZZCIGNA",40]
["AARP UHC MEDICARE COMPLETE","J2930 - PR METHYLPREDNISOLONE INJECTION",null,null,null,null,"HSN PARTIAL",40]
["AARP UHC MEDICARE COMPLETE","J3010 - PR FENTANYL CITRATE INJECITON",null,null,null,null,"ZZZUNITED",40]
["AARP UHC MEDICARE COMPLETE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ",null,null,null,null,"MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL",40]
["AARP UHC MEDICARE COMPLETE","J3490 - PR DRUGS UNCLASSIFIED INJECTION",null,null,null,null,"HARVARD PILGRIM HEALTH CARE",38]
["AARP UHC MEDICARE COMPLETE","J3590 - PR UNCLASSIFIED BIOLOGICS",null,null,null,null,"ZZZHEALTH PLANS INC",38]
["AARP UHC MEDICARE COMPLETE","J7121 - PR 5% DEXTROSE IN LAC RINGERS",null,null,null,null,"HEALTH PLANS INC",38]
["AARP UHC MEDICARE COMPLETE","J7131 - PR HYPERTONIC SALINE SOL",null,null,null,null,"OXFORD HEALTH",35]
["AARP UHC MEDICARE COMPLETE","J8540 - PR ORAL DEXAMETHASONE",null,null,null,null,"HUMANA MEDICARE",34]
["AARP UHC MEDICARE COMPLETE","J9041 - PR INJ., VELCADE 0.1 MG",null,null,null,null,"ZZZRAILROAD MEDICARE",34]
["AARP UHC MEDICARE COMPLETE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML",null,null,null,null,"MEDICARE",34]
["AARP UHC MEDICARE COMPLETE","Q5114 - PR INJ OGIVRI 10 MG",null,null,null,null,"TRICARE FOR LIFE",34]
["AARP UHC MEDICARE COMPLETE","Q9967 - LOCM 300-399MG/ML IODINE,1ML",null,null,null,null,"FALLON SCO",34]
["AARP UHC MEDICARE COMPLETE","S0020 - PR INJECTION, BUPIVICAINE HYDRO",null,null,null,null,"HPHC MEDICARE MANAGED",34]
["AETNA","A9576 - INJ PROHANCE MULTIPACK",null,null,null,null,"CCA MEDICARE PREFERRED",34]
["AETNA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA",null,null,null,null,"BCBS MEDICARE MANAGED",34]
["AETNA","C9257 - PR BEVACIZUMAB INJECTION",null,null,null,null,"ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND",34]
["AETNA","J0131 - PR ACETAMINOPHEN INJECTION",null,null,null,null,"TUFTS MEDICARE",34]
["AETNA","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)",null,null,null,null,"TRICARE EAST",34]
["AETNA","J0583 - PR BIVALIRUDIN",null,null,null,null,"TUFTS MEDICARE MANAGED",34]
["AETNA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA",null,null,null,null,"WELLSENSE MEDICARE MANAGED",34]
["AETNA","J0690 - PR CEFAZOLIN SODIUM INJECTION",null,null,null,null,"UBH HPHC",34]
["AETNA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP",null,null,null,null,"CCA",34]
["AETNA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG",null,null,null,null,"CORRECTIONS",34]
["AETNA","J0750 - HIV PREP, FTC/TDF 200/300MG",null,null,null,null,"ZZZCCA ONECARE",34]
["AETNA","J1170 - PR HYDROMORPHONE INJECTION",null,null,null,null,"AETNA MEDICARE MANAGED",34]
["AETNA","J1250 - PR INJ DOBUTAMINE HCL/250 MG",null,null,null,null,"NEIGHBORHOOD PACE",34]
["AETNA","J1561 - PR GAMUNEX-C/GAMMAKED",null,null,null,null,"UNITED COMMUNITY PLAN",34]
["AETNA","J1580 - PR GARAMYCIN GENTAMICIN INJ",null,null,null,null,"AARP UHC MEDICARE COMPLETE",34]
["AETNA","J1815 - PR INSULIN INJECTION",null,null,null,null,"UNITED MEDICARE MANAGED",34]
["AETNA","J1817 - PR INSULIN FOR INSULIN PUMP USE",null,null,null,null,"SENIOR WHOLE HEALTH",34]
["AETNA","J1953 - PR LEVETIRACETAM INJECTION",null,null,null,null,"FALLON MEDICARE MANAGED",34]
["AETNA","J2001 - PR LIDOCAINE INJECTION",null,null,null,null,"WELLCARE",34]
["AETNA","J2270 - PR MORPHINE SULFATE INJECTION",null,null,null,null,"Grand Total",1959]
["AETNA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["AETNA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["AETNA","J2704 - PR INJ, PROPFOL, 10 MG"]
["AETNA","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["AETNA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["AETNA","J3010 - PR FENTANYL CITRATE INJECITON"]
["AETNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AETNA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["AETNA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["AETNA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["AETNA","J7131 - PR HYPERTONIC SALINE SOL"]
["AETNA","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["AETNA","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["AETNA","J8540 - PR ORAL DEXAMETHASONE"]
["AETNA","J9041 - PR INJ., VELCADE 0.1 MG"]
["AETNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AETNA","Q0249 - TOCILIZUMAB FOR COVID-19"]
["AETNA","Q5114 - PR INJ OGIVRI 10 MG"]
["AETNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["AETNA","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["AETNA MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["AETNA MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["AETNA MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["AETNA MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["AETNA MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["AETNA MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["AETNA MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["AETNA MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["AETNA MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["AETNA MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["AETNA MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["AETNA MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["AETNA MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["AETNA MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["AETNA MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["AETNA MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["AETNA MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["AETNA MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["AETNA MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["AETNA MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["AETNA MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["AETNA MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["AETNA MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["AETNA MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["AETNA MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["AETNA MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["AETNA MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["AETNA MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["AETNA MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["AETNA MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["AETNA MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["AETNA MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["AETNA MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["AETNA MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["BCBS","A9576 - INJ PROHANCE MULTIPACK"]
["BCBS","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["BCBS","C9257 - PR BEVACIZUMAB INJECTION"]
["BCBS","J0131 - PR ACETAMINOPHEN INJECTION"]
["BCBS","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["BCBS","J0583 - PR BIVALIRUDIN"]
["BCBS","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["BCBS","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["BCBS","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["BCBS","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["BCBS","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["BCBS","J1170 - PR HYDROMORPHONE INJECTION"]
["BCBS","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["BCBS","J1561 - PR GAMUNEX-C/GAMMAKED"]
["BCBS","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["BCBS","J1815 - PR INSULIN INJECTION"]
["BCBS","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["BCBS","J1953 - PR LEVETIRACETAM INJECTION"]
["BCBS","J2001 - PR LIDOCAINE INJECTION"]
["BCBS","J2270 - PR MORPHINE SULFATE INJECTION"]
["BCBS","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["BCBS","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["BCBS","J2704 - PR INJ, PROPFOL, 10 MG"]
["BCBS","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["BCBS","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["BCBS","J3010 - PR FENTANYL CITRATE INJECITON"]
["BCBS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["BCBS","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["BCBS","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["BCBS","J7131 - PR HYPERTONIC SALINE SOL"]
["BCBS","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["BCBS","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
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["BCBS MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
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["BCBS MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["BCBS MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["BCBS MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["BCBS MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["BCBS MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["BCBS MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["BCBS MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["BCBS MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
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["BCBS MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
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["BCBS MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
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["BCBS OUT OF STATE","J0583 - PR BIVALIRUDIN"]
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["BCBS OUT OF STATE","J1170 - PR HYDROMORPHONE INJECTION"]
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["BCBS OUT OF STATE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
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["BCBS OUT OF STATE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["BCBS OUT OF STATE","J1953 - PR LEVETIRACETAM INJECTION"]
["BCBS OUT OF STATE","J2001 - PR LIDOCAINE INJECTION"]
["BCBS OUT OF STATE","J2270 - PR MORPHINE SULFATE INJECTION"]
["BCBS OUT OF STATE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["BCBS OUT OF STATE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["BCBS OUT OF STATE","J2704 - PR INJ, PROPFOL, 10 MG"]
["BCBS OUT OF STATE","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["BCBS OUT OF STATE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["BCBS OUT OF STATE","J3010 - PR FENTANYL CITRATE INJECITON"]
["BCBS OUT OF STATE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["BCBS OUT OF STATE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["BCBS OUT OF STATE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["BCBS OUT OF STATE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["BCBS OUT OF STATE","J7131 - PR HYPERTONIC SALINE SOL"]
["BCBS OUT OF STATE","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["BCBS OUT OF STATE","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["BCBS OUT OF STATE","J8540 - PR ORAL DEXAMETHASONE"]
["BCBS OUT OF STATE","J9041 - PR INJ., VELCADE 0.1 MG"]
["BCBS OUT OF STATE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["BCBS OUT OF STATE","Q0249 - TOCILIZUMAB FOR COVID-19"]
["BCBS OUT OF STATE","Q5114 - PR INJ OGIVRI 10 MG"]
["BCBS OUT OF STATE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
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["CCA","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["CCA","J0583 - PR BIVALIRUDIN"]
["CCA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["CCA","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["CCA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["CCA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["CCA","J1170 - PR HYDROMORPHONE INJECTION"]
["CCA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["CCA","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["CCA","J1815 - PR INSULIN INJECTION"]
["CCA","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["CCA","J1953 - PR LEVETIRACETAM INJECTION"]
["CCA","J2001 - PR LIDOCAINE INJECTION"]
["CCA","J2270 - PR MORPHINE SULFATE INJECTION"]
["CCA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["CCA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["CCA","J2704 - PR INJ, PROPFOL, 10 MG"]
["CCA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["CCA","J3010 - PR FENTANYL CITRATE INJECITON"]
["CCA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CCA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["CCA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["CCA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["CCA","J7131 - PR HYPERTONIC SALINE SOL"]
["CCA","J8540 - PR ORAL DEXAMETHASONE"]
["CCA","J9041 - PR INJ., VELCADE 0.1 MG"]
["CCA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CCA","Q5114 - PR INJ OGIVRI 10 MG"]
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["CCA MEDICARE PREFERRED","J0583 - PR BIVALIRUDIN"]
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["CCA MEDICARE PREFERRED","J9041 - PR INJ., VELCADE 0.1 MG"]
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["CIGNA","J0583 - PR BIVALIRUDIN"]
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["CIGNA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
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["CIGNA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["CIGNA","J1561 - PR GAMUNEX-C/GAMMAKED"]
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["CIGNA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
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["CIGNA","J2704 - PR INJ, PROPFOL, 10 MG"]
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["CIGNA","J3010 - PR FENTANYL CITRATE INJECITON"]
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["CIGNA","J7131 - PR HYPERTONIC SALINE SOL"]
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["CIGNA","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
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["CORRECTIONS","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
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["CORRECTIONS","J0583 - PR BIVALIRUDIN"]
["CORRECTIONS","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
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["CORRECTIONS","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["CORRECTIONS","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["CORRECTIONS","J1170 - PR HYDROMORPHONE INJECTION"]
["CORRECTIONS","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["CORRECTIONS","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["CORRECTIONS","J1815 - PR INSULIN INJECTION"]
["CORRECTIONS","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["CORRECTIONS","J1953 - PR LEVETIRACETAM INJECTION"]
["CORRECTIONS","J2001 - PR LIDOCAINE INJECTION"]
["CORRECTIONS","J2270 - PR MORPHINE SULFATE INJECTION"]
["CORRECTIONS","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["CORRECTIONS","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["CORRECTIONS","J2704 - PR INJ, PROPFOL, 10 MG"]
["CORRECTIONS","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["CORRECTIONS","J3010 - PR FENTANYL CITRATE INJECITON"]
["CORRECTIONS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["CORRECTIONS","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["CORRECTIONS","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["CORRECTIONS","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["CORRECTIONS","J7131 - PR HYPERTONIC SALINE SOL"]
["CORRECTIONS","J8540 - PR ORAL DEXAMETHASONE"]
["CORRECTIONS","J9041 - PR INJ., VELCADE 0.1 MG"]
["CORRECTIONS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["CORRECTIONS","Q5114 - PR INJ OGIVRI 10 MG"]
["CORRECTIONS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["CORRECTIONS","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
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["FALLON","J0583 - PR BIVALIRUDIN"]
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["FALLON","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["FALLON","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["FALLON","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["FALLON","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["FALLON","J1170 - PR HYDROMORPHONE INJECTION"]
["FALLON","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["FALLON","J1561 - PR GAMUNEX-C/GAMMAKED"]
["FALLON","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["FALLON","J1815 - PR INSULIN INJECTION"]
["FALLON","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["FALLON","J1953 - PR LEVETIRACETAM INJECTION"]
["FALLON","J2001 - PR LIDOCAINE INJECTION"]
["FALLON","J2270 - PR MORPHINE SULFATE INJECTION"]
["FALLON","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["FALLON","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["FALLON","J2704 - PR INJ, PROPFOL, 10 MG"]
["FALLON","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["FALLON","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["FALLON","J3010 - PR FENTANYL CITRATE INJECITON"]
["FALLON","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["FALLON","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["FALLON","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["FALLON","J7131 - PR HYPERTONIC SALINE SOL"]
["FALLON","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["FALLON","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["FALLON","J8540 - PR ORAL DEXAMETHASONE"]
["FALLON","J9041 - PR INJ., VELCADE 0.1 MG"]
["FALLON","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON","Q0249 - TOCILIZUMAB FOR COVID-19"]
["FALLON","Q5114 - PR INJ OGIVRI 10 MG"]
["FALLON","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
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["FALLON MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["FALLON MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["FALLON MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
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["FALLON MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["FALLON MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["FALLON MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["FALLON MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["FALLON MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["FALLON MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["FALLON MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["FALLON MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
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["FALLON MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["FALLON SCO","A9576 - INJ PROHANCE MULTIPACK"]
["FALLON SCO","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["FALLON SCO","C9257 - PR BEVACIZUMAB INJECTION"]
["FALLON SCO","J0131 - PR ACETAMINOPHEN INJECTION"]
["FALLON SCO","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["FALLON SCO","J0583 - PR BIVALIRUDIN"]
["FALLON SCO","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["FALLON SCO","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["FALLON SCO","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["FALLON SCO","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["FALLON SCO","J1170 - PR HYDROMORPHONE INJECTION"]
["FALLON SCO","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["FALLON SCO","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["FALLON SCO","J1815 - PR INSULIN INJECTION"]
["FALLON SCO","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["FALLON SCO","J1953 - PR LEVETIRACETAM INJECTION"]
["FALLON SCO","J2001 - PR LIDOCAINE INJECTION"]
["FALLON SCO","J2270 - PR MORPHINE SULFATE INJECTION"]
["FALLON SCO","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["FALLON SCO","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["FALLON SCO","J2704 - PR INJ, PROPFOL, 10 MG"]
["FALLON SCO","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["FALLON SCO","J3010 - PR FENTANYL CITRATE INJECITON"]
["FALLON SCO","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["FALLON SCO","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["FALLON SCO","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["FALLON SCO","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["FALLON SCO","J7131 - PR HYPERTONIC SALINE SOL"]
["FALLON SCO","J8540 - PR ORAL DEXAMETHASONE"]
["FALLON SCO","J9041 - PR INJ., VELCADE 0.1 MG"]
["FALLON SCO","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["FALLON SCO","Q5114 - PR INJ OGIVRI 10 MG"]
["FALLON SCO","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["FALLON SCO","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HARVARD PILGRIM HEALTH CARE","A9576 - INJ PROHANCE MULTIPACK"]
["HARVARD PILGRIM HEALTH CARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HARVARD PILGRIM HEALTH CARE","C9257 - PR BEVACIZUMAB INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HARVARD PILGRIM HEALTH CARE","J0583 - PR BIVALIRUDIN"]
["HARVARD PILGRIM HEALTH CARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HARVARD PILGRIM HEALTH CARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HARVARD PILGRIM HEALTH CARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HARVARD PILGRIM HEALTH CARE","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HARVARD PILGRIM HEALTH CARE","J1170 - PR HYDROMORPHONE INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HARVARD PILGRIM HEALTH CARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HARVARD PILGRIM HEALTH CARE","J1815 - PR INSULIN INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HARVARD PILGRIM HEALTH CARE","J1953 - PR LEVETIRACETAM INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J2001 - PR LIDOCAINE INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HARVARD PILGRIM HEALTH CARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HARVARD PILGRIM HEALTH CARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["HARVARD PILGRIM HEALTH CARE","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HARVARD PILGRIM HEALTH CARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["HARVARD PILGRIM HEALTH CARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HARVARD PILGRIM HEALTH CARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HARVARD PILGRIM HEALTH CARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HARVARD PILGRIM HEALTH CARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HARVARD PILGRIM HEALTH CARE","J7131 - PR HYPERTONIC SALINE SOL"]
["HARVARD PILGRIM HEALTH CARE","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HARVARD PILGRIM HEALTH CARE","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HARVARD PILGRIM HEALTH CARE","J8540 - PR ORAL DEXAMETHASONE"]
["HARVARD PILGRIM HEALTH CARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["HARVARD PILGRIM HEALTH CARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HARVARD PILGRIM HEALTH CARE","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HARVARD PILGRIM HEALTH CARE","Q5114 - PR INJ OGIVRI 10 MG"]
["HARVARD PILGRIM HEALTH CARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HEALTH PLANS INC","A9576 - INJ PROHANCE MULTIPACK"]
["HEALTH PLANS INC","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HEALTH PLANS INC","C9257 - PR BEVACIZUMAB INJECTION"]
["HEALTH PLANS INC","J0131 - PR ACETAMINOPHEN INJECTION"]
["HEALTH PLANS INC","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HEALTH PLANS INC","J0583 - PR BIVALIRUDIN"]
["HEALTH PLANS INC","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HEALTH PLANS INC","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HEALTH PLANS INC","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HEALTH PLANS INC","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HEALTH PLANS INC","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HEALTH PLANS INC","J1170 - PR HYDROMORPHONE INJECTION"]
["HEALTH PLANS INC","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HEALTH PLANS INC","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HEALTH PLANS INC","J1815 - PR INSULIN INJECTION"]
["HEALTH PLANS INC","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HEALTH PLANS INC","J1953 - PR LEVETIRACETAM INJECTION"]
["HEALTH PLANS INC","J2001 - PR LIDOCAINE INJECTION"]
["HEALTH PLANS INC","J2270 - PR MORPHINE SULFATE INJECTION"]
["HEALTH PLANS INC","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HEALTH PLANS INC","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HEALTH PLANS INC","J2704 - PR INJ, PROPFOL, 10 MG"]
["HEALTH PLANS INC","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HEALTH PLANS INC","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HEALTH PLANS INC","J3010 - PR FENTANYL CITRATE INJECITON"]
["HEALTH PLANS INC","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HEALTH PLANS INC","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HEALTH PLANS INC","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HEALTH PLANS INC","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HEALTH PLANS INC","J7131 - PR HYPERTONIC SALINE SOL"]
["HEALTH PLANS INC","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HEALTH PLANS INC","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HEALTH PLANS INC","J8540 - PR ORAL DEXAMETHASONE"]
["HEALTH PLANS INC","J9041 - PR INJ., VELCADE 0.1 MG"]
["HEALTH PLANS INC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HEALTH PLANS INC","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HEALTH PLANS INC","Q5114 - PR INJ OGIVRI 10 MG"]
["HEALTH PLANS INC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HPHC MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["HPHC MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HPHC MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["HPHC MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["HPHC MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HPHC MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["HPHC MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HPHC MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HPHC MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HPHC MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HPHC MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["HPHC MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HPHC MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HPHC MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["HPHC MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HPHC MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["HPHC MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["HPHC MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["HPHC MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HPHC MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HPHC MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["HPHC MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HPHC MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["HPHC MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HPHC MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HPHC MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HPHC MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HPHC MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["HPHC MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["HPHC MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["HPHC MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HPHC MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["HPHC MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HPHC MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN","A9576 - INJ PROHANCE MULTIPACK"]
["HSN","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN","J0583 - PR BIVALIRUDIN"]
["HSN","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN","J1815 - PR INSULIN INJECTION"]
["HSN","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN","J2001 - PR LIDOCAINE INJECTION"]
["HSN","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN","J8540 - PR ORAL DEXAMETHASONE"]
["HSN","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN BAD DEBT","A9576 - INJ PROHANCE MULTIPACK"]
["HSN BAD DEBT","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN BAD DEBT","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN BAD DEBT","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN BAD DEBT","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN BAD DEBT","J0583 - PR BIVALIRUDIN"]
["HSN BAD DEBT","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN BAD DEBT","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN BAD DEBT","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN BAD DEBT","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN BAD DEBT","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN BAD DEBT","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN BAD DEBT","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN BAD DEBT","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN BAD DEBT","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN BAD DEBT","J1815 - PR INSULIN INJECTION"]
["HSN BAD DEBT","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN BAD DEBT","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN BAD DEBT","J2001 - PR LIDOCAINE INJECTION"]
["HSN BAD DEBT","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN BAD DEBT","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN BAD DEBT","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN BAD DEBT","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN BAD DEBT","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN BAD DEBT","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN BAD DEBT","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN BAD DEBT","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN BAD DEBT","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN BAD DEBT","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN BAD DEBT","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN BAD DEBT","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN BAD DEBT","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN BAD DEBT","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN BAD DEBT","J8540 - PR ORAL DEXAMETHASONE"]
["HSN BAD DEBT","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN BAD DEBT","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN BAD DEBT","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN BAD DEBT","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN BAD DEBT","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN BAD DEBT","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN CONFIDENTIAL","A9576 - INJ PROHANCE MULTIPACK"]
["HSN CONFIDENTIAL","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN CONFIDENTIAL","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN CONFIDENTIAL","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN CONFIDENTIAL","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN CONFIDENTIAL","J0583 - PR BIVALIRUDIN"]
["HSN CONFIDENTIAL","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN CONFIDENTIAL","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN CONFIDENTIAL","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN CONFIDENTIAL","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN CONFIDENTIAL","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN CONFIDENTIAL","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN CONFIDENTIAL","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN CONFIDENTIAL","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN CONFIDENTIAL","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN CONFIDENTIAL","J1815 - PR INSULIN INJECTION"]
["HSN CONFIDENTIAL","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN CONFIDENTIAL","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN CONFIDENTIAL","J2001 - PR LIDOCAINE INJECTION"]
["HSN CONFIDENTIAL","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN CONFIDENTIAL","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN CONFIDENTIAL","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN CONFIDENTIAL","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN CONFIDENTIAL","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN CONFIDENTIAL","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN CONFIDENTIAL","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN CONFIDENTIAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN CONFIDENTIAL","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN CONFIDENTIAL","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN CONFIDENTIAL","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN CONFIDENTIAL","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN CONFIDENTIAL","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN CONFIDENTIAL","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN CONFIDENTIAL","J8540 - PR ORAL DEXAMETHASONE"]
["HSN CONFIDENTIAL","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN CONFIDENTIAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN CONFIDENTIAL","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN CONFIDENTIAL","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN CONFIDENTIAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN CONFIDENTIAL","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN DENTAL","A9576 - INJ PROHANCE MULTIPACK"]
["HSN DENTAL","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN DENTAL","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN DENTAL","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN DENTAL","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN DENTAL","J0583 - PR BIVALIRUDIN"]
["HSN DENTAL","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN DENTAL","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN DENTAL","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN DENTAL","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN DENTAL","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN DENTAL","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN DENTAL","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN DENTAL","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN DENTAL","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN DENTAL","J1815 - PR INSULIN INJECTION"]
["HSN DENTAL","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN DENTAL","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN DENTAL","J2001 - PR LIDOCAINE INJECTION"]
["HSN DENTAL","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN DENTAL","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN DENTAL","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN DENTAL","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN DENTAL","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN DENTAL","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN DENTAL","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN DENTAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN DENTAL","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN DENTAL","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN DENTAL","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN DENTAL","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN DENTAL","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN DENTAL","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN DENTAL","J8540 - PR ORAL DEXAMETHASONE"]
["HSN DENTAL","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN DENTAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN DENTAL","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN DENTAL","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN DENTAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN DENTAL","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HSN PARTIAL","A9576 - INJ PROHANCE MULTIPACK"]
["HSN PARTIAL","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HSN PARTIAL","C9257 - PR BEVACIZUMAB INJECTION"]
["HSN PARTIAL","J0131 - PR ACETAMINOPHEN INJECTION"]
["HSN PARTIAL","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HSN PARTIAL","J0583 - PR BIVALIRUDIN"]
["HSN PARTIAL","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HSN PARTIAL","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HSN PARTIAL","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HSN PARTIAL","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HSN PARTIAL","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["HSN PARTIAL","J1170 - PR HYDROMORPHONE INJECTION"]
["HSN PARTIAL","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HSN PARTIAL","J1561 - PR GAMUNEX-C/GAMMAKED"]
["HSN PARTIAL","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HSN PARTIAL","J1815 - PR INSULIN INJECTION"]
["HSN PARTIAL","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HSN PARTIAL","J1953 - PR LEVETIRACETAM INJECTION"]
["HSN PARTIAL","J2001 - PR LIDOCAINE INJECTION"]
["HSN PARTIAL","J2270 - PR MORPHINE SULFATE INJECTION"]
["HSN PARTIAL","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HSN PARTIAL","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HSN PARTIAL","J2704 - PR INJ, PROPFOL, 10 MG"]
["HSN PARTIAL","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["HSN PARTIAL","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HSN PARTIAL","J3010 - PR FENTANYL CITRATE INJECITON"]
["HSN PARTIAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HSN PARTIAL","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HSN PARTIAL","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HSN PARTIAL","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HSN PARTIAL","J7131 - PR HYPERTONIC SALINE SOL"]
["HSN PARTIAL","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["HSN PARTIAL","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["HSN PARTIAL","J8540 - PR ORAL DEXAMETHASONE"]
["HSN PARTIAL","J9041 - PR INJ., VELCADE 0.1 MG"]
["HSN PARTIAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HSN PARTIAL","Q0249 - TOCILIZUMAB FOR COVID-19"]
["HSN PARTIAL","Q5114 - PR INJ OGIVRI 10 MG"]
["HSN PARTIAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HSN PARTIAL","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["HUMANA MEDICARE","A9576 - INJ PROHANCE MULTIPACK"]
["HUMANA MEDICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["HUMANA MEDICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["HUMANA MEDICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["HUMANA MEDICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["HUMANA MEDICARE","J0583 - PR BIVALIRUDIN"]
["HUMANA MEDICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["HUMANA MEDICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["HUMANA MEDICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["HUMANA MEDICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["HUMANA MEDICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["HUMANA MEDICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["HUMANA MEDICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["HUMANA MEDICARE","J1815 - PR INSULIN INJECTION"]
["HUMANA MEDICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["HUMANA MEDICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["HUMANA MEDICARE","J2001 - PR LIDOCAINE INJECTION"]
["HUMANA MEDICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["HUMANA MEDICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["HUMANA MEDICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["HUMANA MEDICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["HUMANA MEDICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["HUMANA MEDICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["HUMANA MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["HUMANA MEDICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["HUMANA MEDICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["HUMANA MEDICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["HUMANA MEDICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["HUMANA MEDICARE","J8540 - PR ORAL DEXAMETHASONE"]
["HUMANA MEDICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["HUMANA MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["HUMANA MEDICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["HUMANA MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["HUMANA MEDICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","A9576 - INJ PROHANCE MULTIPACK"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","C9257 - PR BEVACIZUMAB INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0131 - PR ACETAMINOPHEN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0583 - PR BIVALIRUDIN"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1170 - PR HYDROMORPHONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1561 - PR GAMUNEX-C/GAMMAKED"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1815 - PR INSULIN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J1953 - PR LEVETIRACETAM INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2001 - PR LIDOCAINE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2270 - PR MORPHINE SULFATE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2704 - PR INJ, PROPFOL, 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J3010 - PR FENTANYL CITRATE INJECITON"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J7131 - PR HYPERTONIC SALINE SOL"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J8540 - PR ORAL DEXAMETHASONE"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","J9041 - PR INJ., VELCADE 0.1 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","Q0249 - TOCILIZUMAB FOR COVID-19"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","Q5114 - PR INJ OGIVRI 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN COMMERCIAL","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","A9576 - INJ PROHANCE MULTIPACK"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","C9257 - PR BEVACIZUMAB INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0131 - PR ACETAMINOPHEN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0583 - PR BIVALIRUDIN"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1170 - PR HYDROMORPHONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1561 - PR GAMUNEX-C/GAMMAKED"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1815 - PR INSULIN INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J1953 - PR LEVETIRACETAM INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2001 - PR LIDOCAINE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2270 - PR MORPHINE SULFATE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2704 - PR INJ, PROPFOL, 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J3010 - PR FENTANYL CITRATE INJECITON"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J7131 - PR HYPERTONIC SALINE SOL"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J8540 - PR ORAL DEXAMETHASONE"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","J9041 - PR INJ., VELCADE 0.1 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","Q0249 - TOCILIZUMAB FOR COVID-19"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","Q5114 - PR INJ OGIVRI 10 MG"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MASS GENERAL BRIGHAM HEALTH PLAN PRIME","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["MEDICARE","A9576 - INJ PROHANCE MULTIPACK"]
["MEDICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["MEDICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["MEDICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["MEDICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["MEDICARE","J0583 - PR BIVALIRUDIN"]
["MEDICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["MEDICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["MEDICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["MEDICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["MEDICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["MEDICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["MEDICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["MEDICARE","J1815 - PR INSULIN INJECTION"]
["MEDICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["MEDICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["MEDICARE","J2001 - PR LIDOCAINE INJECTION"]
["MEDICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["MEDICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["MEDICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["MEDICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["MEDICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["MEDICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["MEDICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["MEDICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["MEDICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["MEDICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["MEDICARE","J8540 - PR ORAL DEXAMETHASONE"]
["MEDICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["MEDICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["MEDICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["NEIGHBORHOOD PACE","A9576 - INJ PROHANCE MULTIPACK"]
["NEIGHBORHOOD PACE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["NEIGHBORHOOD PACE","C9257 - PR BEVACIZUMAB INJECTION"]
["NEIGHBORHOOD PACE","J0131 - PR ACETAMINOPHEN INJECTION"]
["NEIGHBORHOOD PACE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["NEIGHBORHOOD PACE","J0583 - PR BIVALIRUDIN"]
["NEIGHBORHOOD PACE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["NEIGHBORHOOD PACE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["NEIGHBORHOOD PACE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["NEIGHBORHOOD PACE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["NEIGHBORHOOD PACE","J1170 - PR HYDROMORPHONE INJECTION"]
["NEIGHBORHOOD PACE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["NEIGHBORHOOD PACE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["NEIGHBORHOOD PACE","J1815 - PR INSULIN INJECTION"]
["NEIGHBORHOOD PACE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["NEIGHBORHOOD PACE","J1953 - PR LEVETIRACETAM INJECTION"]
["NEIGHBORHOOD PACE","J2001 - PR LIDOCAINE INJECTION"]
["NEIGHBORHOOD PACE","J2270 - PR MORPHINE SULFATE INJECTION"]
["NEIGHBORHOOD PACE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["NEIGHBORHOOD PACE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["NEIGHBORHOOD PACE","J2704 - PR INJ, PROPFOL, 10 MG"]
["NEIGHBORHOOD PACE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["NEIGHBORHOOD PACE","J3010 - PR FENTANYL CITRATE INJECITON"]
["NEIGHBORHOOD PACE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["NEIGHBORHOOD PACE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["NEIGHBORHOOD PACE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["NEIGHBORHOOD PACE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["NEIGHBORHOOD PACE","J7131 - PR HYPERTONIC SALINE SOL"]
["NEIGHBORHOOD PACE","J8540 - PR ORAL DEXAMETHASONE"]
["NEIGHBORHOOD PACE","J9041 - PR INJ., VELCADE 0.1 MG"]
["NEIGHBORHOOD PACE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["NEIGHBORHOOD PACE","Q5114 - PR INJ OGIVRI 10 MG"]
["NEIGHBORHOOD PACE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["NEIGHBORHOOD PACE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["OXFORD HEALTH","A9576 - INJ PROHANCE MULTIPACK"]
["OXFORD HEALTH","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["OXFORD HEALTH","C9257 - PR BEVACIZUMAB INJECTION"]
["OXFORD HEALTH","J0131 - PR ACETAMINOPHEN INJECTION"]
["OXFORD HEALTH","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["OXFORD HEALTH","J0583 - PR BIVALIRUDIN"]
["OXFORD HEALTH","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["OXFORD HEALTH","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["OXFORD HEALTH","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["OXFORD HEALTH","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["OXFORD HEALTH","J1170 - PR HYDROMORPHONE INJECTION"]
["OXFORD HEALTH","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["OXFORD HEALTH","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["OXFORD HEALTH","J1815 - PR INSULIN INJECTION"]
["OXFORD HEALTH","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["OXFORD HEALTH","J1953 - PR LEVETIRACETAM INJECTION"]
["OXFORD HEALTH","J2001 - PR LIDOCAINE INJECTION"]
["OXFORD HEALTH","J2270 - PR MORPHINE SULFATE INJECTION"]
["OXFORD HEALTH","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["OXFORD HEALTH","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["OXFORD HEALTH","J2704 - PR INJ, PROPFOL, 10 MG"]
["OXFORD HEALTH","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["OXFORD HEALTH","J3010 - PR FENTANYL CITRATE INJECITON"]
["OXFORD HEALTH","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["OXFORD HEALTH","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["OXFORD HEALTH","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["OXFORD HEALTH","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["OXFORD HEALTH","J7131 - PR HYPERTONIC SALINE SOL"]
["OXFORD HEALTH","J8540 - PR ORAL DEXAMETHASONE"]
["OXFORD HEALTH","J9041 - PR INJ., VELCADE 0.1 MG"]
["OXFORD HEALTH","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["OXFORD HEALTH","Q0249 - TOCILIZUMAB FOR COVID-19"]
["OXFORD HEALTH","Q5114 - PR INJ OGIVRI 10 MG"]
["OXFORD HEALTH","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["OXFORD HEALTH","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["SENIOR WHOLE HEALTH","A9576 - INJ PROHANCE MULTIPACK"]
["SENIOR WHOLE HEALTH","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["SENIOR WHOLE HEALTH","C9257 - PR BEVACIZUMAB INJECTION"]
["SENIOR WHOLE HEALTH","J0131 - PR ACETAMINOPHEN INJECTION"]
["SENIOR WHOLE HEALTH","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["SENIOR WHOLE HEALTH","J0583 - PR BIVALIRUDIN"]
["SENIOR WHOLE HEALTH","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["SENIOR WHOLE HEALTH","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["SENIOR WHOLE HEALTH","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["SENIOR WHOLE HEALTH","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["SENIOR WHOLE HEALTH","J1170 - PR HYDROMORPHONE INJECTION"]
["SENIOR WHOLE HEALTH","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["SENIOR WHOLE HEALTH","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["SENIOR WHOLE HEALTH","J1815 - PR INSULIN INJECTION"]
["SENIOR WHOLE HEALTH","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["SENIOR WHOLE HEALTH","J1953 - PR LEVETIRACETAM INJECTION"]
["SENIOR WHOLE HEALTH","J2001 - PR LIDOCAINE INJECTION"]
["SENIOR WHOLE HEALTH","J2270 - PR MORPHINE SULFATE INJECTION"]
["SENIOR WHOLE HEALTH","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["SENIOR WHOLE HEALTH","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["SENIOR WHOLE HEALTH","J2704 - PR INJ, PROPFOL, 10 MG"]
["SENIOR WHOLE HEALTH","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["SENIOR WHOLE HEALTH","J3010 - PR FENTANYL CITRATE INJECITON"]
["SENIOR WHOLE HEALTH","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["SENIOR WHOLE HEALTH","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["SENIOR WHOLE HEALTH","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["SENIOR WHOLE HEALTH","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["SENIOR WHOLE HEALTH","J7131 - PR HYPERTONIC SALINE SOL"]
["SENIOR WHOLE HEALTH","J8540 - PR ORAL DEXAMETHASONE"]
["SENIOR WHOLE HEALTH","J9041 - PR INJ., VELCADE 0.1 MG"]
["SENIOR WHOLE HEALTH","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["SENIOR WHOLE HEALTH","Q5114 - PR INJ OGIVRI 10 MG"]
["SENIOR WHOLE HEALTH","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["SENIOR WHOLE HEALTH","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TRICARE EAST","A9576 - INJ PROHANCE MULTIPACK"]
["TRICARE EAST","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TRICARE EAST","C9257 - PR BEVACIZUMAB INJECTION"]
["TRICARE EAST","J0131 - PR ACETAMINOPHEN INJECTION"]
["TRICARE EAST","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TRICARE EAST","J0583 - PR BIVALIRUDIN"]
["TRICARE EAST","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TRICARE EAST","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TRICARE EAST","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TRICARE EAST","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TRICARE EAST","J1170 - PR HYDROMORPHONE INJECTION"]
["TRICARE EAST","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TRICARE EAST","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TRICARE EAST","J1815 - PR INSULIN INJECTION"]
["TRICARE EAST","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TRICARE EAST","J1953 - PR LEVETIRACETAM INJECTION"]
["TRICARE EAST","J2001 - PR LIDOCAINE INJECTION"]
["TRICARE EAST","J2270 - PR MORPHINE SULFATE INJECTION"]
["TRICARE EAST","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TRICARE EAST","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TRICARE EAST","J2704 - PR INJ, PROPFOL, 10 MG"]
["TRICARE EAST","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TRICARE EAST","J3010 - PR FENTANYL CITRATE INJECITON"]
["TRICARE EAST","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TRICARE EAST","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TRICARE EAST","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TRICARE EAST","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TRICARE EAST","J7131 - PR HYPERTONIC SALINE SOL"]
["TRICARE EAST","J8540 - PR ORAL DEXAMETHASONE"]
["TRICARE EAST","J9041 - PR INJ., VELCADE 0.1 MG"]
["TRICARE EAST","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TRICARE EAST","Q5114 - PR INJ OGIVRI 10 MG"]
["TRICARE EAST","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TRICARE EAST","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TRICARE FOR LIFE","A9576 - INJ PROHANCE MULTIPACK"]
["TRICARE FOR LIFE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TRICARE FOR LIFE","C9257 - PR BEVACIZUMAB INJECTION"]
["TRICARE FOR LIFE","J0131 - PR ACETAMINOPHEN INJECTION"]
["TRICARE FOR LIFE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TRICARE FOR LIFE","J0583 - PR BIVALIRUDIN"]
["TRICARE FOR LIFE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TRICARE FOR LIFE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TRICARE FOR LIFE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TRICARE FOR LIFE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TRICARE FOR LIFE","J1170 - PR HYDROMORPHONE INJECTION"]
["TRICARE FOR LIFE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TRICARE FOR LIFE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TRICARE FOR LIFE","J1815 - PR INSULIN INJECTION"]
["TRICARE FOR LIFE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TRICARE FOR LIFE","J1953 - PR LEVETIRACETAM INJECTION"]
["TRICARE FOR LIFE","J2001 - PR LIDOCAINE INJECTION"]
["TRICARE FOR LIFE","J2270 - PR MORPHINE SULFATE INJECTION"]
["TRICARE FOR LIFE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TRICARE FOR LIFE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TRICARE FOR LIFE","J2704 - PR INJ, PROPFOL, 10 MG"]
["TRICARE FOR LIFE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TRICARE FOR LIFE","J3010 - PR FENTANYL CITRATE INJECITON"]
["TRICARE FOR LIFE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TRICARE FOR LIFE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TRICARE FOR LIFE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TRICARE FOR LIFE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TRICARE FOR LIFE","J7131 - PR HYPERTONIC SALINE SOL"]
["TRICARE FOR LIFE","J8540 - PR ORAL DEXAMETHASONE"]
["TRICARE FOR LIFE","J9041 - PR INJ., VELCADE 0.1 MG"]
["TRICARE FOR LIFE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TRICARE FOR LIFE","Q5114 - PR INJ OGIVRI 10 MG"]
["TRICARE FOR LIFE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TRICARE FOR LIFE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TUFTS","A9576 - INJ PROHANCE MULTIPACK"]
["TUFTS","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TUFTS","C9257 - PR BEVACIZUMAB INJECTION"]
["TUFTS","J0131 - PR ACETAMINOPHEN INJECTION"]
["TUFTS","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TUFTS","J0583 - PR BIVALIRUDIN"]
["TUFTS","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TUFTS","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TUFTS","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TUFTS","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["TUFTS","J1170 - PR HYDROMORPHONE INJECTION"]
["TUFTS","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TUFTS","J1561 - PR GAMUNEX-C/GAMMAKED"]
["TUFTS","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TUFTS","J1815 - PR INSULIN INJECTION"]
["TUFTS","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TUFTS","J1953 - PR LEVETIRACETAM INJECTION"]
["TUFTS","J2001 - PR LIDOCAINE INJECTION"]
["TUFTS","J2270 - PR MORPHINE SULFATE INJECTION"]
["TUFTS","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TUFTS","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TUFTS","J2704 - PR INJ, PROPFOL, 10 MG"]
["TUFTS","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["TUFTS","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TUFTS","J3010 - PR FENTANYL CITRATE INJECITON"]
["TUFTS","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TUFTS","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TUFTS","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TUFTS","J7131 - PR HYPERTONIC SALINE SOL"]
["TUFTS","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["TUFTS","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["TUFTS","J8540 - PR ORAL DEXAMETHASONE"]
["TUFTS","J9041 - PR INJ., VELCADE 0.1 MG"]
["TUFTS","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS","Q0249 - TOCILIZUMAB FOR COVID-19"]
["TUFTS","Q5114 - PR INJ OGIVRI 10 MG"]
["TUFTS","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TUFTS CONNCARE/QHP","A9576 - INJ PROHANCE MULTIPACK"]
["TUFTS CONNCARE/QHP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TUFTS CONNCARE/QHP","C9257 - PR BEVACIZUMAB INJECTION"]
["TUFTS CONNCARE/QHP","J0131 - PR ACETAMINOPHEN INJECTION"]
["TUFTS CONNCARE/QHP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TUFTS CONNCARE/QHP","J0583 - PR BIVALIRUDIN"]
["TUFTS CONNCARE/QHP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TUFTS CONNCARE/QHP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TUFTS CONNCARE/QHP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS CONNCARE/QHP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TUFTS CONNCARE/QHP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["TUFTS CONNCARE/QHP","J1170 - PR HYDROMORPHONE INJECTION"]
["TUFTS CONNCARE/QHP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TUFTS CONNCARE/QHP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["TUFTS CONNCARE/QHP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TUFTS CONNCARE/QHP","J1815 - PR INSULIN INJECTION"]
["TUFTS CONNCARE/QHP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TUFTS CONNCARE/QHP","J1953 - PR LEVETIRACETAM INJECTION"]
["TUFTS CONNCARE/QHP","J2001 - PR LIDOCAINE INJECTION"]
["TUFTS CONNCARE/QHP","J2270 - PR MORPHINE SULFATE INJECTION"]
["TUFTS CONNCARE/QHP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TUFTS CONNCARE/QHP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TUFTS CONNCARE/QHP","J2704 - PR INJ, PROPFOL, 10 MG"]
["TUFTS CONNCARE/QHP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["TUFTS CONNCARE/QHP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TUFTS CONNCARE/QHP","J3010 - PR FENTANYL CITRATE INJECITON"]
["TUFTS CONNCARE/QHP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS CONNCARE/QHP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TUFTS CONNCARE/QHP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TUFTS CONNCARE/QHP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TUFTS CONNCARE/QHP","J7131 - PR HYPERTONIC SALINE SOL"]
["TUFTS CONNCARE/QHP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["TUFTS CONNCARE/QHP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["TUFTS CONNCARE/QHP","J8540 - PR ORAL DEXAMETHASONE"]
["TUFTS CONNCARE/QHP","J9041 - PR INJ., VELCADE 0.1 MG"]
["TUFTS CONNCARE/QHP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS CONNCARE/QHP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["TUFTS CONNCARE/QHP","Q5114 - PR INJ OGIVRI 10 MG"]
["TUFTS CONNCARE/QHP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS CONNCARE/QHP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TUFTS MEDICARE","A9576 - INJ PROHANCE MULTIPACK"]
["TUFTS MEDICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TUFTS MEDICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["TUFTS MEDICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["TUFTS MEDICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TUFTS MEDICARE","J0583 - PR BIVALIRUDIN"]
["TUFTS MEDICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TUFTS MEDICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TUFTS MEDICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS MEDICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TUFTS MEDICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["TUFTS MEDICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TUFTS MEDICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TUFTS MEDICARE","J1815 - PR INSULIN INJECTION"]
["TUFTS MEDICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TUFTS MEDICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["TUFTS MEDICARE","J2001 - PR LIDOCAINE INJECTION"]
["TUFTS MEDICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["TUFTS MEDICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TUFTS MEDICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TUFTS MEDICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["TUFTS MEDICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TUFTS MEDICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["TUFTS MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS MEDICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TUFTS MEDICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TUFTS MEDICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TUFTS MEDICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["TUFTS MEDICARE","J8540 - PR ORAL DEXAMETHASONE"]
["TUFTS MEDICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["TUFTS MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS MEDICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["TUFTS MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS MEDICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["TUFTS MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["TUFTS MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["TUFTS MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["TUFTS MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["TUFTS MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["TUFTS MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["TUFTS MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["TUFTS MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["TUFTS MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["TUFTS MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["TUFTS MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["TUFTS MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["TUFTS MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["TUFTS MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["TUFTS MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["TUFTS MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["TUFTS MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["TUFTS MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["TUFTS MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["TUFTS MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["TUFTS MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["TUFTS MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["TUFTS MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["TUFTS MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["TUFTS MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["TUFTS MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["TUFTS MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["TUFTS MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["TUFTS MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["TUFTS MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["TUFTS MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["TUFTS MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["TUFTS MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["TUFTS MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UBH HPHC","A9576 - INJ PROHANCE MULTIPACK"]
["UBH HPHC","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UBH HPHC","C9257 - PR BEVACIZUMAB INJECTION"]
["UBH HPHC","J0131 - PR ACETAMINOPHEN INJECTION"]
["UBH HPHC","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UBH HPHC","J0583 - PR BIVALIRUDIN"]
["UBH HPHC","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UBH HPHC","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UBH HPHC","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UBH HPHC","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UBH HPHC","J1170 - PR HYDROMORPHONE INJECTION"]
["UBH HPHC","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UBH HPHC","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UBH HPHC","J1815 - PR INSULIN INJECTION"]
["UBH HPHC","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UBH HPHC","J1953 - PR LEVETIRACETAM INJECTION"]
["UBH HPHC","J2001 - PR LIDOCAINE INJECTION"]
["UBH HPHC","J2270 - PR MORPHINE SULFATE INJECTION"]
["UBH HPHC","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UBH HPHC","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UBH HPHC","J2704 - PR INJ, PROPFOL, 10 MG"]
["UBH HPHC","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UBH HPHC","J3010 - PR FENTANYL CITRATE INJECITON"]
["UBH HPHC","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UBH HPHC","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UBH HPHC","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UBH HPHC","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UBH HPHC","J7131 - PR HYPERTONIC SALINE SOL"]
["UBH HPHC","J8540 - PR ORAL DEXAMETHASONE"]
["UBH HPHC","J9041 - PR INJ., VELCADE 0.1 MG"]
["UBH HPHC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UBH HPHC","Q5114 - PR INJ OGIVRI 10 MG"]
["UBH HPHC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UBH HPHC","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UNICARE","A9576 - INJ PROHANCE MULTIPACK"]
["UNICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UNICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["UNICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["UNICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UNICARE","J0583 - PR BIVALIRUDIN"]
["UNICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UNICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UNICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UNICARE","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["UNICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["UNICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UNICARE","J1561 - PR GAMUNEX-C/GAMMAKED"]
["UNICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UNICARE","J1815 - PR INSULIN INJECTION"]
["UNICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UNICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["UNICARE","J2001 - PR LIDOCAINE INJECTION"]
["UNICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["UNICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UNICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UNICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["UNICARE","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["UNICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UNICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["UNICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UNICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UNICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UNICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["UNICARE","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["UNICARE","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["UNICARE","J8540 - PR ORAL DEXAMETHASONE"]
["UNICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["UNICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNICARE","Q0249 - TOCILIZUMAB FOR COVID-19"]
["UNICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["UNICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
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["UNITED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
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["UNITED","J0131 - PR ACETAMINOPHEN INJECTION"]
["UNITED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UNITED","J0583 - PR BIVALIRUDIN"]
["UNITED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UNITED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UNITED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNITED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UNITED","J1170 - PR HYDROMORPHONE INJECTION"]
["UNITED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UNITED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UNITED","J1815 - PR INSULIN INJECTION"]
["UNITED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UNITED","J1953 - PR LEVETIRACETAM INJECTION"]
["UNITED","J2001 - PR LIDOCAINE INJECTION"]
["UNITED","J2270 - PR MORPHINE SULFATE INJECTION"]
["UNITED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UNITED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UNITED","J2704 - PR INJ, PROPFOL, 10 MG"]
["UNITED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UNITED","J3010 - PR FENTANYL CITRATE INJECITON"]
["UNITED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UNITED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UNITED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UNITED","J7131 - PR HYPERTONIC SALINE SOL"]
["UNITED","J8540 - PR ORAL DEXAMETHASONE"]
["UNITED","J9041 - PR INJ., VELCADE 0.1 MG"]
["UNITED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNITED","Q0249 - TOCILIZUMAB FOR COVID-19"]
["UNITED","Q5114 - PR INJ OGIVRI 10 MG"]
["UNITED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UNITED","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["UNITED","J1561 - PR GAMUNEX-C/GAMMAKED"]
["UNITED","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["UNITED","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["UNITED","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["UNITED COMMUNITY PLAN","A9576 - INJ PROHANCE MULTIPACK"]
["UNITED COMMUNITY PLAN","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UNITED COMMUNITY PLAN","C9257 - PR BEVACIZUMAB INJECTION"]
["UNITED COMMUNITY PLAN","J0131 - PR ACETAMINOPHEN INJECTION"]
["UNITED COMMUNITY PLAN","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UNITED COMMUNITY PLAN","J0583 - PR BIVALIRUDIN"]
["UNITED COMMUNITY PLAN","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UNITED COMMUNITY PLAN","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UNITED COMMUNITY PLAN","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNITED COMMUNITY PLAN","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UNITED COMMUNITY PLAN","J1170 - PR HYDROMORPHONE INJECTION"]
["UNITED COMMUNITY PLAN","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UNITED COMMUNITY PLAN","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UNITED COMMUNITY PLAN","J1815 - PR INSULIN INJECTION"]
["UNITED COMMUNITY PLAN","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UNITED COMMUNITY PLAN","J1953 - PR LEVETIRACETAM INJECTION"]
["UNITED COMMUNITY PLAN","J2001 - PR LIDOCAINE INJECTION"]
["UNITED COMMUNITY PLAN","J2270 - PR MORPHINE SULFATE INJECTION"]
["UNITED COMMUNITY PLAN","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UNITED COMMUNITY PLAN","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UNITED COMMUNITY PLAN","J2704 - PR INJ, PROPFOL, 10 MG"]
["UNITED COMMUNITY PLAN","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UNITED COMMUNITY PLAN","J3010 - PR FENTANYL CITRATE INJECITON"]
["UNITED COMMUNITY PLAN","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED COMMUNITY PLAN","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UNITED COMMUNITY PLAN","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UNITED COMMUNITY PLAN","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UNITED COMMUNITY PLAN","J7131 - PR HYPERTONIC SALINE SOL"]
["UNITED COMMUNITY PLAN","J8540 - PR ORAL DEXAMETHASONE"]
["UNITED COMMUNITY PLAN","J9041 - PR INJ., VELCADE 0.1 MG"]
["UNITED COMMUNITY PLAN","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNITED COMMUNITY PLAN","Q5114 - PR INJ OGIVRI 10 MG"]
["UNITED COMMUNITY PLAN","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED COMMUNITY PLAN","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UNITED MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["UNITED MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UNITED MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["UNITED MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["UNITED MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UNITED MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["UNITED MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UNITED MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UNITED MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UNITED MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UNITED MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["UNITED MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UNITED MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UNITED MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["UNITED MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UNITED MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["UNITED MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["UNITED MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["UNITED MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UNITED MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UNITED MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["UNITED MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UNITED MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["UNITED MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UNITED MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UNITED MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UNITED MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UNITED MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["UNITED MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["UNITED MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["UNITED MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UNITED MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["UNITED MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UNITED MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["UPHAMS CORNER ESP","A9576 - INJ PROHANCE MULTIPACK"]
["UPHAMS CORNER ESP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["UPHAMS CORNER ESP","C9257 - PR BEVACIZUMAB INJECTION"]
["UPHAMS CORNER ESP","J0131 - PR ACETAMINOPHEN INJECTION"]
["UPHAMS CORNER ESP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["UPHAMS CORNER ESP","J0583 - PR BIVALIRUDIN"]
["UPHAMS CORNER ESP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["UPHAMS CORNER ESP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["UPHAMS CORNER ESP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["UPHAMS CORNER ESP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["UPHAMS CORNER ESP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["UPHAMS CORNER ESP","J1170 - PR HYDROMORPHONE INJECTION"]
["UPHAMS CORNER ESP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["UPHAMS CORNER ESP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["UPHAMS CORNER ESP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["UPHAMS CORNER ESP","J1815 - PR INSULIN INJECTION"]
["UPHAMS CORNER ESP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["UPHAMS CORNER ESP","J1953 - PR LEVETIRACETAM INJECTION"]
["UPHAMS CORNER ESP","J2001 - PR LIDOCAINE INJECTION"]
["UPHAMS CORNER ESP","J2270 - PR MORPHINE SULFATE INJECTION"]
["UPHAMS CORNER ESP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["UPHAMS CORNER ESP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["UPHAMS CORNER ESP","J2704 - PR INJ, PROPFOL, 10 MG"]
["UPHAMS CORNER ESP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["UPHAMS CORNER ESP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["UPHAMS CORNER ESP","J3010 - PR FENTANYL CITRATE INJECITON"]
["UPHAMS CORNER ESP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["UPHAMS CORNER ESP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["UPHAMS CORNER ESP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["UPHAMS CORNER ESP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["UPHAMS CORNER ESP","J7131 - PR HYPERTONIC SALINE SOL"]
["UPHAMS CORNER ESP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["UPHAMS CORNER ESP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["UPHAMS CORNER ESP","J8540 - PR ORAL DEXAMETHASONE"]
["UPHAMS CORNER ESP","J9041 - PR INJ., VELCADE 0.1 MG"]
["UPHAMS CORNER ESP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["UPHAMS CORNER ESP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["UPHAMS CORNER ESP","Q5114 - PR INJ OGIVRI 10 MG"]
["UPHAMS CORNER ESP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["UPHAMS CORNER ESP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["WELLCARE","A9576 - INJ PROHANCE MULTIPACK"]
["WELLCARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["WELLCARE","C9257 - PR BEVACIZUMAB INJECTION"]
["WELLCARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["WELLCARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["WELLCARE","J0583 - PR BIVALIRUDIN"]
["WELLCARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["WELLCARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["WELLCARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["WELLCARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["WELLCARE","J1170 - PR HYDROMORPHONE INJECTION"]
["WELLCARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["WELLCARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["WELLCARE","J1815 - PR INSULIN INJECTION"]
["WELLCARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["WELLCARE","J1953 - PR LEVETIRACETAM INJECTION"]
["WELLCARE","J2001 - PR LIDOCAINE INJECTION"]
["WELLCARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["WELLCARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["WELLCARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["WELLCARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["WELLCARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["WELLCARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["WELLCARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WELLCARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["WELLCARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["WELLCARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["WELLCARE","J7131 - PR HYPERTONIC SALINE SOL"]
["WELLCARE","J8540 - PR ORAL DEXAMETHASONE"]
["WELLCARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["WELLCARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLCARE","Q5114 - PR INJ OGIVRI 10 MG"]
["WELLCARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLCARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","A9576 - INJ PROHANCE MULTIPACK"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","C9257 - PR BEVACIZUMAB INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0131 - PR ACETAMINOPHEN INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0583 - PR BIVALIRUDIN"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1170 - PR HYDROMORPHONE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1561 - PR GAMUNEX-C/GAMMAKED"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1815 - PR INSULIN INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J1953 - PR LEVETIRACETAM INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2001 - PR LIDOCAINE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2270 - PR MORPHINE SULFATE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2704 - PR INJ, PROPFOL, 10 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J3010 - PR FENTANYL CITRATE INJECITON"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J7131 - PR HYPERTONIC SALINE SOL"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J8540 - PR ORAL DEXAMETHASONE"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","J9041 - PR INJ., VELCADE 0.1 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q0249 - TOCILIZUMAB FOR COVID-19"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q5114 - PR INJ OGIVRI 10 MG"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLSENSE HEALTH MEDICAID NEW HAMPSHIRE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["WELLSENSE MEDICARE MANAGED","A9576 - INJ PROHANCE MULTIPACK"]
["WELLSENSE MEDICARE MANAGED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["WELLSENSE MEDICARE MANAGED","C9257 - PR BEVACIZUMAB INJECTION"]
["WELLSENSE MEDICARE MANAGED","J0131 - PR ACETAMINOPHEN INJECTION"]
["WELLSENSE MEDICARE MANAGED","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["WELLSENSE MEDICARE MANAGED","J0583 - PR BIVALIRUDIN"]
["WELLSENSE MEDICARE MANAGED","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["WELLSENSE MEDICARE MANAGED","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["WELLSENSE MEDICARE MANAGED","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["WELLSENSE MEDICARE MANAGED","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["WELLSENSE MEDICARE MANAGED","J1170 - PR HYDROMORPHONE INJECTION"]
["WELLSENSE MEDICARE MANAGED","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["WELLSENSE MEDICARE MANAGED","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["WELLSENSE MEDICARE MANAGED","J1815 - PR INSULIN INJECTION"]
["WELLSENSE MEDICARE MANAGED","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["WELLSENSE MEDICARE MANAGED","J1953 - PR LEVETIRACETAM INJECTION"]
["WELLSENSE MEDICARE MANAGED","J2001 - PR LIDOCAINE INJECTION"]
["WELLSENSE MEDICARE MANAGED","J2270 - PR MORPHINE SULFATE INJECTION"]
["WELLSENSE MEDICARE MANAGED","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["WELLSENSE MEDICARE MANAGED","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["WELLSENSE MEDICARE MANAGED","J2704 - PR INJ, PROPFOL, 10 MG"]
["WELLSENSE MEDICARE MANAGED","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["WELLSENSE MEDICARE MANAGED","J3010 - PR FENTANYL CITRATE INJECITON"]
["WELLSENSE MEDICARE MANAGED","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WELLSENSE MEDICARE MANAGED","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["WELLSENSE MEDICARE MANAGED","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["WELLSENSE MEDICARE MANAGED","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["WELLSENSE MEDICARE MANAGED","J7131 - PR HYPERTONIC SALINE SOL"]
["WELLSENSE MEDICARE MANAGED","J8540 - PR ORAL DEXAMETHASONE"]
["WELLSENSE MEDICARE MANAGED","J9041 - PR INJ., VELCADE 0.1 MG"]
["WELLSENSE MEDICARE MANAGED","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WELLSENSE MEDICARE MANAGED","Q5114 - PR INJ OGIVRI 10 MG"]
["WELLSENSE MEDICARE MANAGED","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WELLSENSE MEDICARE MANAGED","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["WORKERS COMP","A9576 - INJ PROHANCE MULTIPACK"]
["WORKERS COMP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["WORKERS COMP","C9257 - PR BEVACIZUMAB INJECTION"]
["WORKERS COMP","J0131 - PR ACETAMINOPHEN INJECTION"]
["WORKERS COMP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["WORKERS COMP","J0583 - PR BIVALIRUDIN"]
["WORKERS COMP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["WORKERS COMP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["WORKERS COMP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["WORKERS COMP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["WORKERS COMP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["WORKERS COMP","J1170 - PR HYDROMORPHONE INJECTION"]
["WORKERS COMP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["WORKERS COMP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["WORKERS COMP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["WORKERS COMP","J1815 - PR INSULIN INJECTION"]
["WORKERS COMP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["WORKERS COMP","J1953 - PR LEVETIRACETAM INJECTION"]
["WORKERS COMP","J2001 - PR LIDOCAINE INJECTION"]
["WORKERS COMP","J2270 - PR MORPHINE SULFATE INJECTION"]
["WORKERS COMP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["WORKERS COMP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["WORKERS COMP","J2704 - PR INJ, PROPFOL, 10 MG"]
["WORKERS COMP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["WORKERS COMP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["WORKERS COMP","J3010 - PR FENTANYL CITRATE INJECITON"]
["WORKERS COMP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["WORKERS COMP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["WORKERS COMP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["WORKERS COMP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["WORKERS COMP","J7131 - PR HYPERTONIC SALINE SOL"]
["WORKERS COMP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["WORKERS COMP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["WORKERS COMP","J8540 - PR ORAL DEXAMETHASONE"]
["WORKERS COMP","J9041 - PR INJ., VELCADE 0.1 MG"]
["WORKERS COMP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["WORKERS COMP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["WORKERS COMP","Q5114 - PR INJ OGIVRI 10 MG"]
["WORKERS COMP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["WORKERS COMP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZAETNA","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZAETNA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZAETNA","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZAETNA","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZAETNA","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZAETNA","J0583 - PR BIVALIRUDIN"]
["ZZZAETNA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZAETNA","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZAETNA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZAETNA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZAETNA","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZAETNA","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZAETNA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZAETNA","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZAETNA","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZAETNA","J1815 - PR INSULIN INJECTION"]
["ZZZAETNA","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZAETNA","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZAETNA","J2001 - PR LIDOCAINE INJECTION"]
["ZZZAETNA","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZAETNA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZAETNA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZAETNA","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZAETNA","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZAETNA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZAETNA","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZAETNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZAETNA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZAETNA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZAETNA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZAETNA","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZAETNA","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZAETNA","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZAETNA","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZAETNA","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZAETNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZAETNA","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZAETNA","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZAETNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZAETNA","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZBU EMPLOYEE WORK COMP","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZBU EMPLOYEE WORK COMP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZBU EMPLOYEE WORK COMP","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZBU EMPLOYEE WORK COMP","J0583 - PR BIVALIRUDIN"]
["ZZZBU EMPLOYEE WORK COMP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZBU EMPLOYEE WORK COMP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZBU EMPLOYEE WORK COMP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZBU EMPLOYEE WORK COMP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZBU EMPLOYEE WORK COMP","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZBU EMPLOYEE WORK COMP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZBU EMPLOYEE WORK COMP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZBU EMPLOYEE WORK COMP","J1815 - PR INSULIN INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZBU EMPLOYEE WORK COMP","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J2001 - PR LIDOCAINE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZBU EMPLOYEE WORK COMP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZBU EMPLOYEE WORK COMP","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZBU EMPLOYEE WORK COMP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZBU EMPLOYEE WORK COMP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZBU EMPLOYEE WORK COMP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZBU EMPLOYEE WORK COMP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZBU EMPLOYEE WORK COMP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZBU EMPLOYEE WORK COMP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZBU EMPLOYEE WORK COMP","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZBU EMPLOYEE WORK COMP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZBU EMPLOYEE WORK COMP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZBU EMPLOYEE WORK COMP","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZBU EMPLOYEE WORK COMP","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZBU EMPLOYEE WORK COMP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZBU EMPLOYEE WORK COMP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZBU EMPLOYEE WORK COMP","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZBU EMPLOYEE WORK COMP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZBU EMPLOYEE WORK COMP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
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["ZZZCCA ONECARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZCCA ONECARE","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZCCA ONECARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZCCA ONECARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZCCA ONECARE","J0583 - PR BIVALIRUDIN"]
["ZZZCCA ONECARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZCCA ONECARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZCCA ONECARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZCCA ONECARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZCCA ONECARE","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZCCA ONECARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCCA ONECARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZCCA ONECARE","J1815 - PR INSULIN INJECTION"]
["ZZZCCA ONECARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZCCA ONECARE","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZCCA ONECARE","J2001 - PR LIDOCAINE INJECTION"]
["ZZZCCA ONECARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZCCA ONECARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZCCA ONECARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZCCA ONECARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZCCA ONECARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZCCA ONECARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZCCA ONECARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCCA ONECARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZCCA ONECARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZCCA ONECARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZCCA ONECARE","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZCCA ONECARE","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZCCA ONECARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZCCA ONECARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCCA ONECARE","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZCCA ONECARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZCCA ONECARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZCIGNA","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZCIGNA","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZCIGNA","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZCIGNA","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZCIGNA","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZCIGNA","J0583 - PR BIVALIRUDIN"]
["ZZZCIGNA","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZCIGNA","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZCIGNA","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZCIGNA","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZCIGNA","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZCIGNA","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZCIGNA","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCIGNA","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZCIGNA","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZCIGNA","J1815 - PR INSULIN INJECTION"]
["ZZZCIGNA","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZCIGNA","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZCIGNA","J2001 - PR LIDOCAINE INJECTION"]
["ZZZCIGNA","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZCIGNA","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZCIGNA","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZCIGNA","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZCIGNA","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZCIGNA","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZCIGNA","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZCIGNA","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCIGNA","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZCIGNA","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZCIGNA","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZCIGNA","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZCIGNA","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZCIGNA","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZCIGNA","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZCIGNA","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZCIGNA","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCIGNA","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZCIGNA","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZCIGNA","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZCIGNA","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZCITY OF BOSTON WORK COMP","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZCITY OF BOSTON WORK COMP","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZCITY OF BOSTON WORK COMP","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZCITY OF BOSTON WORK COMP","J0583 - PR BIVALIRUDIN"]
["ZZZCITY OF BOSTON WORK COMP","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZCITY OF BOSTON WORK COMP","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZCITY OF BOSTON WORK COMP","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZCITY OF BOSTON WORK COMP","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZCITY OF BOSTON WORK COMP","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCITY OF BOSTON WORK COMP","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZCITY OF BOSTON WORK COMP","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZCITY OF BOSTON WORK COMP","J1815 - PR INSULIN INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZCITY OF BOSTON WORK COMP","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J2001 - PR LIDOCAINE INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZCITY OF BOSTON WORK COMP","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZCITY OF BOSTON WORK COMP","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZCITY OF BOSTON WORK COMP","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZCITY OF BOSTON WORK COMP","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZCITY OF BOSTON WORK COMP","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCITY OF BOSTON WORK COMP","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZCITY OF BOSTON WORK COMP","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZCITY OF BOSTON WORK COMP","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZCITY OF BOSTON WORK COMP","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZCITY OF BOSTON WORK COMP","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZCITY OF BOSTON WORK COMP","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZCITY OF BOSTON WORK COMP","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZCITY OF BOSTON WORK COMP","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZCITY OF BOSTON WORK COMP","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCITY OF BOSTON WORK COMP","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZCITY OF BOSTON WORK COMP","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZCITY OF BOSTON WORK COMP","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZCITY OF BOSTON WORK COMP","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0583 - PR BIVALIRUDIN"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1815 - PR INSULIN INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2001 - PR LIDOCAINE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZCOVID19 HRSA UNINSURED TESTING AND TREATMENT FUND","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZHEALTH PLANS INC","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZHEALTH PLANS INC","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZHEALTH PLANS INC","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZHEALTH PLANS INC","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZHEALTH PLANS INC","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZHEALTH PLANS INC","J0583 - PR BIVALIRUDIN"]
["ZZZHEALTH PLANS INC","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZHEALTH PLANS INC","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZHEALTH PLANS INC","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZHEALTH PLANS INC","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZHEALTH PLANS INC","J0750 - HIV PREP, FTC/TDF 200/300MG"]
["ZZZHEALTH PLANS INC","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZHEALTH PLANS INC","J1561 - PR GAMUNEX-C/GAMMAKED"]
["ZZZHEALTH PLANS INC","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZHEALTH PLANS INC","J1815 - PR INSULIN INJECTION"]
["ZZZHEALTH PLANS INC","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZHEALTH PLANS INC","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZHEALTH PLANS INC","J2001 - PR LIDOCAINE INJECTION"]
["ZZZHEALTH PLANS INC","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZHEALTH PLANS INC","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZHEALTH PLANS INC","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZHEALTH PLANS INC","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZHEALTH PLANS INC","J2919 - PR INJ, METHYLPRED SOD SUCC 5MG"]
["ZZZHEALTH PLANS INC","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZHEALTH PLANS INC","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZHEALTH PLANS INC","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZHEALTH PLANS INC","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZHEALTH PLANS INC","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZHEALTH PLANS INC","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZHEALTH PLANS INC","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZHEALTH PLANS INC","J7307 - ETONOGESTREL IMPLANT SYSTEM"]
["ZZZHEALTH PLANS INC","J7608 - ACETYLCYSTEINE NON-COMP UNIT"]
["ZZZHEALTH PLANS INC","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZHEALTH PLANS INC","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZHEALTH PLANS INC","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZHEALTH PLANS INC","Q0249 - TOCILIZUMAB FOR COVID-19"]
["ZZZHEALTH PLANS INC","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZHEALTH PLANS INC","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZRAILROAD MEDICARE","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZRAILROAD MEDICARE","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZRAILROAD MEDICARE","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZRAILROAD MEDICARE","J0131 - PR ACETAMINOPHEN INJECTION"]
["ZZZRAILROAD MEDICARE","J0137 - PR INJ, ACETAMINOPHEN (HIKMA)"]
["ZZZRAILROAD MEDICARE","J0583 - PR BIVALIRUDIN"]
["ZZZRAILROAD MEDICARE","J0688 - INJ CEFAZOLIN SODIUM, HIKMA"]
["ZZZRAILROAD MEDICARE","J0690 - PR CEFAZOLIN SODIUM INJECTION"]
["ZZZRAILROAD MEDICARE","J0702 - PR BETAMETHASONE ACET&SOD PHOSP"]
["ZZZRAILROAD MEDICARE","J0736 - PR INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG"]
["ZZZRAILROAD MEDICARE","J1170 - PR HYDROMORPHONE INJECTION"]
["ZZZRAILROAD MEDICARE","J1250 - PR INJ DOBUTAMINE HCL/250 MG"]
["ZZZRAILROAD MEDICARE","J1580 - PR GARAMYCIN GENTAMICIN INJ"]
["ZZZRAILROAD MEDICARE","J1815 - PR INSULIN INJECTION"]
["ZZZRAILROAD MEDICARE","J1817 - PR INSULIN FOR INSULIN PUMP USE"]
["ZZZRAILROAD MEDICARE","J1953 - PR LEVETIRACETAM INJECTION"]
["ZZZRAILROAD MEDICARE","J2001 - PR LIDOCAINE INJECTION"]
["ZZZRAILROAD MEDICARE","J2270 - PR MORPHINE SULFATE INJECTION"]
["ZZZRAILROAD MEDICARE","J2310 - PR INJ NALOXONE HYDROCHLORIDE"]
["ZZZRAILROAD MEDICARE","J2598 - PR INJ, VASOPRESSIN, 1 UNIT"]
["ZZZRAILROAD MEDICARE","J2704 - PR INJ, PROPFOL, 10 MG"]
["ZZZRAILROAD MEDICARE","J2930 - PR METHYLPREDNISOLONE INJECTION"]
["ZZZRAILROAD MEDICARE","J3010 - PR FENTANYL CITRATE INJECITON"]
["ZZZRAILROAD MEDICARE","J3301 - PR TRIAMCINOLONE ACETONIDE INJ"]
["ZZZRAILROAD MEDICARE","J3490 - PR DRUGS UNCLASSIFIED INJECTION"]
["ZZZRAILROAD MEDICARE","J3590 - PR UNCLASSIFIED BIOLOGICS"]
["ZZZRAILROAD MEDICARE","J7121 - PR 5% DEXTROSE IN LAC RINGERS"]
["ZZZRAILROAD MEDICARE","J7131 - PR HYPERTONIC SALINE SOL"]
["ZZZRAILROAD MEDICARE","J8540 - PR ORAL DEXAMETHASONE"]
["ZZZRAILROAD MEDICARE","J9041 - PR INJ., VELCADE 0.1 MG"]
["ZZZRAILROAD MEDICARE","P9047 - PR ALBUMIN (HUMAN), 25%, 50ML"]
["ZZZRAILROAD MEDICARE","Q5114 - PR INJ OGIVRI 10 MG"]
["ZZZRAILROAD MEDICARE","Q9967 - LOCM 300-399MG/ML IODINE,1ML"]
["ZZZRAILROAD MEDICARE","S0020 - PR INJECTION, BUPIVICAINE HYDRO"]
["ZZZUNITED","A9576 - INJ PROHANCE MULTIPACK"]
["ZZZUNITED","C9113 - PR INJ PANTOPRAZOLE SODIUM, VIA"]
["ZZZUNITED","C9257 - PR BEVACIZUMAB INJECTION"]
["ZZZUNITED","J0131 - PR ACETAMINOPHEN INJECTION"]
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{"sheet":"HCPCSCombo","index":29,"n_rows":57,"n_cols":16,"rows_kept":57,"cut":false,"hidden":true,"merged":[]}
[]
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